William Agger - Academia.edu (original) (raw)

Papers by William Agger

Diagnostic Microbiology and Infectious Disease, 2019

To the Editor We appreciate the interest of Surme and Balkan regarding our publication in DMID (S... more To the Editor We appreciate the interest of Surme and Balkan regarding our publication in DMID (Sanders et al., 2019). We concur with many of their comments but wish to clarify some of their points. First, in the 3 years before our interventions, despite repeated educational sessions, no persistent decrease in the high rate of contamination of approximately 3.2% was achieved. This education included all standard techniques for blood culturing, such as non-palpation of the venipuncture site after skin decontamination. They point out that amongst the contaminating organisms, the percentage of Streptococcus sp. increased rather than decreased. They hypothesized that if the masks were the cause of improvement, the Streptococcus isolates should have decreased because those genera are predominately found in the mouth and would be expected to have decreased with the use of face masks. However, statistically, this percentage of increase in Streptococcus sp. was not significant (P = 0.45). In fact, Propionibacterium sp., known to be part of normal human skin flora (Grice and Segre, 2011), was the only genera to significantly increase (P = 0.046), both by Fisher Exact tests. Furthermore, neither gloves nor skin decontamination can be expected to be totally successful in removing bacteria on skin, including streptococci that had been transferred from mouths before the start of the phlebotomy. In addition, due to cost, none of these isolates were ge-Contents lists available at ScienceDirect

Medieval Norse and the Bi-directional Spread of Epidemic Disease between Europe and Northeastern America: A New Hypothesis

Granulomas of the Vocal Cords Caused by Sporothrix Schenckii

The Laryngoscope, 1985

A 42-year-old female acquired an acute respiratory infection one week after working in a sphagnum... more A 42-year-old female acquired an acute respiratory infection one week after working in a sphagnum moss packing plant. Three and one half months later direct laryngoscopic examination, done because of persistent hoarseness, revealed granulomas of the left true cord. Initial biopsy showed noncaseating granulomas, and a repeat biopsy with fungal cultures grew Sporothrix schenckii. The patient was treated with an oral solution of saturated potassium iodide and gradually improved although mild hoarseness has persisted.

Clinics in orthopedic surgery, 2015

Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are... more Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.

Blastomycosis diagnosed in a nonhyperendemic area

WMJ : official publication of the State Medical Society of Wisconsin, 2014

Blastomycosis, caused by the dimorphic fungus Blastomyces dermatitidis, is hyperendemic in northe... more Blastomycosis, caused by the dimorphic fungus Blastomyces dermatitidis, is hyperendemic in northern Wisconsin and is unevenly distributed in the rest of the state and contiguous Minnesota. Clinical presentation of this illness has been characterized by localized outbreaks and sporadic cases in endemic areas. Using ICD-9 CPT codes, we queried our electronic health record system to identify cases of blastomycosis diagnosed at Gundersen Health System over a 32-year period. Gundersen serves a region outside the hyperendemic area of Wisconsin. Records so identified were reviewed for demographic and clinical features. We attempted to interview patients with a blastomycosis diagnosis from 2002 through 2006. Blastomycosis data also were collected from the states of Wisconsin and Minnesota from 2002 through 2006 and assessed for trends. Thirty-six patients had blastomycosis diagnoses at Gundersen Health System during the study period, as identified by ICD-9 code. Of these, 10 were excluded f...

Antibiotic resistance: unnatural selection in the office and on the farm

WMJ : official publication of the State Medical Society of Wisconsin, 2002

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2014

Rates of trichinellosis have declined significantly in the United States due to improved pork pro... more Rates of trichinellosis have declined significantly in the United States due to improved pork production practices and public awareness of the danger of eating raw or undercooked pork. In April 2011, the Minnesota Department of Health received a report of presumptive trichinellosis in a 50-year-old man with a history of wild boar consumption. A public health investigation was initiated. Medical record reviews and patient and family interviews were conducted. Trichinella species serology was performed on patient and family serum samples, and larval identification was attempted on clinical specimens and meat samples. The index patient harvested a wild boar from an Iowa game farm; he processed the meat after returning home and developed gastrointestinal symptoms 2 days later. Four days after his illness onset, all 5 family members consumed a roast from the boar. The index patient sought healthcare 4 times after illness onset before being definitively diagnosed with trichinellosis. Foll...

Nitrofurantoin-induced granulomatous hepatitis

Urology, 1981

Nitrofurantoin has been described as a cause of both hepatocellular cholestatic hepatic injury. A... more Nitrofurantoin has been described as a cause of both hepatocellular cholestatic hepatic injury. A case report of a patient in whom granulomatous hepatitis developed attributed to nitrofurantoin is given.

WMJ : official publication of the State Medical Society of Wisconsin, 2006

Previously considered a disease of childhood, pertussis is now also recognized as a significant p... more Previously considered a disease of childhood, pertussis is now also recognized as a significant problem for adolescents and adults; however, diagnosing pertussis remains problematic due to its nonspecific clinical presentation and the time delay, sensitivity/specificity, and expense of testing. To be effective, therapy is best started very early in the illness, when the illness is seldom recognized. Other than chemoprophylaxis in families with a non-immune infant, antibiotic therapy is controversial due to the ubiquitous nature of pertussis, its similarity to other respiratory infections, increased prevalence, prolonged outbreaks, and difficulties in determining true exposures in the general community. If antimicrobial therapy is used extensively for whooping cough prevention, drug reactions and increased bacterial resistance are expected. Likewise, without laboratory confirmation of infection, isolation of individuals is difficult and expensive. Fortunately, 2 new Food and Drug Adm...

Mayo Clinic Proceedings, 1998

To compare the medical management of bacteremic pneumococcal pneumonia at a university-based and ... more To compare the medical management of bacteremic pneumococcal pneumonia at a university-based and a community-based teaching hospital and evaluate strategies for performance measurement and subsequent improvement. • Design: We conducted a retrospective cohort study involving a 450-bed university hospital in the inner city and a 400-bed private hospital in a rural community. • Material and Methods: The medical records of all adults with bacteremic pneumococcal pneumonia admitted to a university and a community hospital during a 5-year period were reviewed. Information about patient age, sex, underlying medical condition, severity of disease, health-care insurance, management, and outcome was collected and analyzed. • Results: Patients at the two hospitals were similar in underlying illnesses and severity of disease. In comparison with the community hospital, resource expenditure was greater at the university hospital, where all 11 identified diagnostic measures and treat-Pneumonia, a leading cause of in-hospital mortality, is one of the most costly medical illnesses. 1,2 In this era of managed care, hospital evaluations are based on "report card" information that includes data on cost and outcomes for expensive diseases such as pneumonia.' Previous studies have shown that comparisons of hospital performance for pneumonia care based on severity-adjusted mortality rates are

Journal of Clinical Microbiology, 2005

Penicillin-resistant Bacteroides melaninogenicus

JAMA: The Journal of the American Medical Association, 1982

To the Editor.— The choice of antimicrobial therapy for anaerobic lung infections remains controv... more To the Editor.— The choice of antimicrobial therapy for anaerobic lung infections remains controversial. These infections usually result from penicillin-sensitive oral flora. However, isolates of penicillin-resistant Bacteroides fragilis and Bacteroides melaninogenicus from such cases have been reported. 1 Despite these resistant organisms, several reports have indicated that such infections may respond as well to penicillin as to clindamycin or other antimicrobial drugs directed against the penicillin-resistant species. 2 We recently treated a cavitating anaerobic pneumonia that did not respond to penicillin or to ampicillin in one of our patients. Clinical response occurred only after administration of clindamycin phosphate was begun. Report of a Case.— A 68-year-old diabetic man had development of rigors, fever, and a productive cough. After seven days of illness, a chest roentgenogram disclosed a right lower lobe pneumonia. After hospitalization, intravenous (IV) administration of penicillin G sodium, 600,000 units every six hours for four days, followed by

On Toothpicking in Early Hominids

Current Anthropology, 2004

The data on toothpicking presented by Hlusko (CA 44: 738–41) represent the earliest currently kno... more The data on toothpicking presented by Hlusko (CA 44: 738–41) represent the earliest currently known nonlithic tool use by hominids. From an evolutionary perspective, the main question that follows from her interesting article is why the various species of early Homo were compelled to pick their teeth in the first place. We suggest that toothpicking behavior may represent indirect evidence for the evolution of the biological capacity for language. There has been considerable debate surrounding the issue of when the capacity for modern human language evolved. Some argue that the origins of modern human language are associated with the emergence of the capacity for complex symbolic thought during the Upper Paleolithic era, approximately 32,000 years ago (Noble and Davidson 1991). Others believe that earlier hominids, in particular Neanderthals, who have been shown to possess a hyoid bone similar to that of Homo sapiens, engaged in language communication by at least 60,000 years ago (Arensburg et al. 1989). Wolpoff (1999) presents data that suggest that the major elements of neural organization associated with language were present as early as 2 million years ago. We believe that Hlusko’s results support the hypothesis that the biological capacity for human language had evolved in the earliest species of Homo, as early as 2.5 million years ago. Universally in modern Homo sapiens, the development of speech quickens between the ages of five to ten months of life during the babbling phase with a baby’s first syllables (Holowka and Petitto 2002). This developmental phase appears to be related to a biofeedback between proprioception afferent information carried by cranial nerve V and the auditory nerve (cranial nerve VIII) to the superior temporal gyrus. There, after processing usually in the left dominant hemisphere, a verbal response is sent through the Broca’s motor area via cranial nerves VII, IX, X, and XII. Cranial nerve V is the largest

Clinical Infectious Diseases, 2009

Clinical Infectious Diseases, 2004

An immunosuppressed heart transplant recipient developed Exophiala jeanselmei infection on the se... more An immunosuppressed heart transplant recipient developed Exophiala jeanselmei infection on the second toe. After unsuccessful treatment with different antifungal drugs, the infection responded to a high-dose regimen of oral terbinafine (an antifungal agent not yet approved in the United States for use against the dematiaceous fungi) and warm packs. This is, to our knowledge, the only known case of successful terbinafine treatment of E. jeanselmei infection. Exophiala jeanselmei is a dematiaceous hyphomycete commonly found in soil, decaying vegetation, and rotting wood [1]. Traumatic inoculation of E. jeanselmei can lead to a variety of subcutaneous infections, including mycetoma, chromoblastomycosis, or phaeohyphomycosis. In immunosuppressed organ transplant recipients, E. jeanselmei is the most common dematiaceous fungus associated with skin infections: it is present in up to 32% of cases, with an associated mortality rate of up to 18% [2]. We report a subcutaneous infection with E. jeanselmei in a heart transplant recipient. The infection was refractory to numerous trials of antifungal therapy and to surgical debridement. Eventually, successful treatment was achieved with a regimen of oral terbinafine and warm-towel therapy. To our knowledge, this is the only known case of successful treatment of E. jeanselmei with oral terbinafine. Case report. A 45-year-old woman with a history of heart transplantation, receipt of immunosuppressive therapy (tacrolimus, ∼5 mg q.d., modified by blood levels; and prednisone, 0.25 mg q.d., modified by cardiac biopsy results), and insulinrequiring, adult-onset diabetes mellitus, developed a medial

Clinical Infectious Diseases, 2005

We describe a case of cow-transmitted parapoxvirus infection-also known as milkers' nodules-after... more We describe a case of cow-transmitted parapoxvirus infection-also known as milkers' nodules-after a hematopoietic stem cell transplantation for multiple myeloma. The infection was complicated by erythema multiforme and acute exacerbation of graft-versus-host disease. Parapoxvirus was confirmed by electron microscopy. The natural history of milker's nodules in immunocompetent hosts is described and compared to that in our immunocompromised patient. Milkers' nodules, also known as paravaccinia and pseudovaccinia, are cutaneous lesions caused by infection with parapoxvirus of bovine origin [1]. In the otherwise healthy host, these nodules are relatively benign and self-limiting, but in the immunocompromised host, the outcome can be variable. We report a case of parapox infection complicated by erythema multiforme and graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) for multiple myeloma. Case report. A 40-year-old dairy farmer with a history of multiple myeloma underwent high-dose chemotherapy with autologous stem cell transplantation followed 3 months later by receipt of a nonmyeloablative allogeneic stem cell transplant from an HLA-identical sibling. He received cyclosporine and prednisone for GVHD prophylaxis and had an uneventful

Mucormycosis. A complication of critical care

Archives of Internal Medicine, 1978

Lethal nosocomial mucormycosis developed in three previously well individuals while they were rec... more Lethal nosocomial mucormycosis developed in three previously well individuals while they were receiving intensive care for acute hemorrhagic pancreatitis, for cardiogenic shock, and for a ruptured intra-abdominal aortic aneurysm. In two cases, the condition was first seen as progressive cavitary pneumonia refractory to antibacterial therapy; Mucoraceae was identified in all three patients only at autopsy. Each patient had received large doses of corticosteroids and broad-spectrum antibiotics, and all had suffered from respiratory failure, acute renal failure with acidosis, and severe hyperglycemia in association with total parenteral nutrition. Mucoraceae should be regarded as an additional nosocomial pathogen in the setting of advanced life-support care.

Hepatitis Due to Recurrent Lyme Disease

Annals of Internal Medicine, 1988

... MARK H. GOELLNER, MD; WILLIAM A. AGGER, MD; JOHN H. BURGESS, MD; and PAUL H. DURAY, MD Gunder... more ... MARK H. GOELLNER, MD; WILLIAM A. AGGER, MD; JOHN H. BURGESS, MD; and PAUL H. DURAY, MD Gundersen Clinic; La Crosse, Wisconsin; and Fox Chase Cancer ... He-patic parenchyma (B) with spi-rochetal forms (arrows) (Dieterle stain; original magnification x 400). ...

Septicemia from Heparin-Lock Needles

Annals of Internal Medicine, 1977

... REFERENCES 1. KUSSMAN MJ, GOLDSTEIN HH, GLEASON RE: The clinical course of diabetic nephropat... more ... REFERENCES 1. KUSSMAN MJ, GOLDSTEIN HH, GLEASON RE: The clinical course of diabetic nephropathy. ... CARY A. PRESANT, MD CAROL KLAHR, MS, RN ROGER SANTALA, MD The Jewish Hospital of St. Louis 216 South Kings Highway St. Louis, MO 63110 ...

Isolating Borrelia burgdorferi from Erythema Migrans

Annals of Internal Medicine, 1993