I Potasman

Publications of I Potasman

• A retrospective six-year national survey of P. multocida infections in Israel.

  Authors: William Nseir, M Giladi, I Moroz, A E Moses, S Benenson, R Finkelstein, M Dan, B Chazan, J Bishara, G Ben-Dror, D Hassin, N Peled, G Rahav, M Grupper, I Potasman

  Scandinavian journal of infectious diseases. 06/2009;

  Pasteurella multocida is the commonest organism infecting pet bites. Anecdotal reports tend to overemphasize dramatic outcomes. We aimed to study a large database of P. multocida infections. ThisPasteurella multocida is the commonest organism infecting pet bites. Anecdotal reports tend to overemphasize dramatic outcomes. We aimed to study a large database of P. multocida infections. This retrospective survey of P. multocida infections in Israeli hospitals refers to the y 2000-2005. Clinical microbiologists were contacted by email and asked to perform a back-search of their hospital's records for isolates of P. multocida. The charts of patients growing P. multocida were abstracted into a structured questionnaire. 77 cases were identified in 12 hospitals, yielding an annual incidence of 0.19/100,000. The mean age was 49.2+/-26.5 y and the mortality rate was 2.6%. Those who died were >65 y of age, had diabetes mellitus or cirrhosis and were bacteraemic. One-third of the cases occurred in people aged >/=65 y. Cats caused most of these infections (54%). Surgery for debridement was common (53.7%), but no-one required amputation; a second- and third-look operation was necessary in all these patients. Bacteraemia was found in 32.5% of patients and was significantly more common among those aged >60 y (p=0.044). Hospitalized patients with P. multocida have a favourable prognosis, apart from elderly and bacteraemic patients with comorbidities. Surgery and reoperations may be required in about half of the patients.

• The added value of peripheral blood cell morphology in the diagnosis and management of infectious diseases--part 2: illustrative cases.

  Authors: I Potasman, M Prokocimer

  Postgraduate medical journal. 12/2008; 84(997):586-9.

  The previous review dealt with the diagnostic yield of peripheral blood smear examination with regard to diagnosis of infectious diseases. In addition to the clinical data, it can provide informationThe previous review dealt with the diagnostic yield of peripheral blood smear examination with regard to diagnosis of infectious diseases. In addition to the clinical data, it can provide information of major clinical significance. At times, it can even replace additional, costly and time-consuming diagnostic modalities. The following clinical vignettes, which are discussed briefly, support these arguments.

• The added value of peripheral blood cell morphology in the diagnosis and management of infectious diseases--part 1: basic concepts.

  Authors: M Prokocimer, I Potasman

  Postgraduate medical journal. 12/2008; 84(997):579-85.

  As automated blood cell analysers and sophisticated diagnostic technologies become widespread, requests for peripheral blood smear (PBS) examination-for the diagnosis of infectious diseases-diminish.As automated blood cell analysers and sophisticated diagnostic technologies become widespread, requests for peripheral blood smear (PBS) examination-for the diagnosis of infectious diseases-diminish. Yet, PBS examination can provide rapid and invaluable information on infection-host susceptibility, aetiology, severity, and systemic impact. Besides direct visualisation of certain microorganisms (for example, Plasmodium, Ehrlichia), PBS examination may detect characteristic footprints left by various infections on the morphology of blood cells, thus yielding the cytologic clues of the disease (for example, Döhle bodies, haemophagocytosis). Additionally, PBS examination may disclose certain infection predisposing conditions (for example, May-Hegglin anomaly, hyposplenism), and several infection related haematological and systemic complications. Combined with a careful medical history and physical examination data, all this information may yield a speedy diagnosis, a rationalised diagnostic work-up, and timely initiation of treatment. The intention of the following review is to highlight the value of PBS, and recommend that PBS examination should be fostered in the diagnostic work-up of infectious diseases.

• Formal Adult Infectious Disease Outpatient Consultations: A Retrospective 6-Year Survey.

  Authors: M Grupper, I Potasman

  Infection. 11/2008;

  BACKGROUND: The field of outpatient infectious disease (ID) consultations is expanding. Surprisingly, limited data are available regarding the scope of formal, adult, outpatient ID consultations.BACKGROUND: The field of outpatient infectious disease (ID) consultations is expanding. Surprisingly, limited data are available regarding the scope of formal, adult, outpatient ID consultations. METHODS: The computerized records of all adult outpatient ID consultations conducted by a single ID expert over the years 2001-2007 were retrospectively analyzed. Demographic, clinical and management characteristics were studied. RESULTS: We identified 619 eligible cases, mostly women (61.4%). The mean age (+/- SD) was 39 +/- 15.5 years, and each patient had 1.3 +/- 0.7 visits on average. In 12% of the cases, symptoms have been fluctuating for >/= 1 year. Most of the cases (54.3%) have been referred for the purpose of management rather than diagnostics. Largest areas leading to ID consultation were post-travel medical conditions (15.5%) and pregnancy-related infections (11%); specific leading categories were viral infections (17.3%), skin and soft tissue syndromes (15.2%) and gastrointestinal syndromes (7.6%). Recurrent, well-characterized infections plus ill-defined syndromes constituted a substantial part of all referrals. Newly discovered findings were elicited in the medical history and physical examination in 3.7% and 2.7% of cases, respectively. CONCLUSIONS: Formal outpatient ID consultations have unique aspects, which differ from "traditional" inpatient consultations. The field offers exciting medical research possibilities and new themes for healthcare executives.

• Hand Infections Following Penetrating Fish Fins or Bones Injuries (FFBI): A Large, Hospital Based, Retrospective Study.

  Authors: R Imberg, I Potasman, Y Weissman, M Grupper

  Infection. 09/2008;

  BACKGROUND: The incidence of hand infections caused by penetrating fish fins or bones injuries (FFBI) is likely to increase following worldwide constant growth of fishery production and consumption.BACKGROUND: The incidence of hand infections caused by penetrating fish fins or bones injuries (FFBI) is likely to increase following worldwide constant growth of fishery production and consumption. Because data on these infections are scarce, the purposes of this study were to describe their clinical characteristics and disease course, and to analyze risk factors for a complicated disease course. METHODS: We studied retrospectively all cases of hospitalized patients with hand infections following FFBI over the years 1999-2006 in a single medical center. Demographic data, underlying diseases, clinical characteristics and disease course were analyzed for each case. Univariate and multivariate analysis were used for analyzing risk factors for a complicated hospitalization course. RESULTS: There were 122 separate episodes of hand infections following FFBI among 116 patients, with a mean age (+/- SD) of 52 +/- 19.7. The majority of cases were women (51.6%), and they arrived significantly later to the hospital after injury. Predisposing conditions (diabetes mellitus, liver disease, rheumatologic disorder, malignancy or chronic steroid treatment) were present in 25% of cases. Most of the cases presented with cellulitis. Cultures of either blood or wound were obtained in ~1/3 of cases, and 40% of them yielded an isolate. Ceftazidime and doxycycline were administered to 68.8% and 96.7% of cases, respectively. Surgical debridement was performed in 34.4% of cases, but there was no case of death or limb amputation. The presence of fever (p = 0.0005) and a predisposing condition (p = 0.035) were independently correlated with a complicated hospitalization course. CONCLUSIONS: The overall prognosis in this largest cohort of hand infections following FFBI was favorable, but immune dysfunction carried a complicated course.

• Flight-associated headaches-prevalence and characteristics.

  Authors: I Potasman, O Rofe, B Weller

  Cephalalgia : an international journal of headache. 06/2008;

  Environmental factors in airplanes may precipitate headaches. We conducted a questionnaire-based study among consecutive travellers to determine the rate, severity and duration of flight-associatedEnvironmental factors in airplanes may precipitate headaches. We conducted a questionnaire-based study among consecutive travellers to determine the rate, severity and duration of flight-associated headaches (FAHA). Of the 906 eligible travellers (mean age 33.3 +/- 13.8 years), 22.3% reported headaches at least once per month. FAHA occurred in 52 travellers (5.7%), of whom 34 were women (P = 0.0023 vs. none FAHA). The duration of pain was 4.0 +/- 10.2 h after takeoff and continued for 5.7 +/- 14.2 h after landing. Migraine was diagnosed in 19.2% of those with FAHA. The magnitude of headache was 6 +/- 2 (on a scale of 1-10). Among those who suffer from FAHA, 45.4% reported that their pain was unilateral, in contrast to 72.7% among those with 'non-flight' headaches (P = 0.019). Nine travellers had headaches when descending to -400 m below sea level, and nine upon climbing to high altitude. This preliminary observation indicates that FAHA is not uncommon and should be further investigated.

• Fluoroquinolones in community-acquired pneumonia when tuberculosis is around: an instructive case.

  Authors: M Grupper, I Potasman

  The American journal of the medical sciences. 03/2008; 335(2):141-4.

  Fluoroquinolones are increasingly used for the treatment of community-acquired pneumonia. However, their use has been associated with a delay in the diagnosis and treatment of pulmonary tuberculosis.Fluoroquinolones are increasingly used for the treatment of community-acquired pneumonia. However, their use has been associated with a delay in the diagnosis and treatment of pulmonary tuberculosis. We describe the clinical and insightful bacteriological course of a 39-year-old patient with pulmonary tuberculosis who had presented as having community-acquired pneumonia and was treated empirically with levofloxacin. The case highlights a major problem associated with the indiscriminate use of fluoroquinolones.

• Enterococcal-associated Lower Respiratory Tract Infections: A Case Report and Literature Review.

  Authors: M Grupper, A Kravtsov, I Potasman

  Infection. 11/2007;

  We report a rare case of bacteremic enterococcal pneumonia in an 81-year-old man, with an indolent disease course. We reviewed the literature concerning lower respiratory tract infections associatedWe report a rare case of bacteremic enterococcal pneumonia in an 81-year-old man, with an indolent disease course. We reviewed the literature concerning lower respiratory tract infections associated with enterococci for the burden, the pathogenesis and the clinical characteristics of these unusual infections.

• Inadequate protection against yellow fever of children visiting endemic areas.

  Authors: I Potasman, N Pick, C Stringer, J N Zuckerman

  The American journal of tropical medicine and hygiene. 12/2001; 65(6):954-7.

  The guidelines of the World Health Organization call for immunization against yellow fever at least 10 days before travel to endemic areas. The goal of this study was to determine whether theseThe guidelines of the World Health Organization call for immunization against yellow fever at least 10 days before travel to endemic areas. The goal of this study was to determine whether these guidelines have been applied in 2 travel clinic settings in teaching hospitals in Israel and the United Kingdom specifically for children traveling to endemic areas. Two groups of children aged 9 months to 15 years (n = 98), who were planning to travel to yellow fever-endemic areas, were evaluated regarding characteristics related to the administration of yellow fever vaccine before travel. Overall, 19 children in both clinics (19.4%; 95% confidence interval, 12.1-28.6) had received their yellow fever vaccination < 10 days before departure (no interclinic difference). Eleven of these children received the vaccine < 7 days before departure. We found that the World Health Organization guidelines for yellow fever vaccination are frequently not followed. An initiative to explain to the public the importance of vaccination well before travel to endemic areas should be undertaken.

• Multiresistant Pseudomonas aeruginosa associated with contaminated transrectal ultrasound.

  Authors: A Paz, H Bauer, I Potasman

  The Journal of hospital infection. 11/2001; 49(2):148-9.

• Candida sepsis following transcervical chorionic villi sampling.

  Authors: A Paz, R Gonen, I Potasman

  Infectious diseases in obstetrics and gynecology. 02/2001; 9(3):147-8.

  BACKGROUND: The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections. Candida sepsis associated with pregnancy is rare. Candida sepsis followingBACKGROUND: The use of invasive devices and broad spectrum antibiotics has increased the rate of candidal superinfections. Candida sepsis associated with pregnancy is rare. Candida sepsis following chorionic villi sampling (CVS) has never been reported. CASE: A 31 -year-old pregnant woman presented with signs of sepsis one day after undergoing transcervical CVS. Blood culture and curettage material yielded C. albicans. She was treated with 400 mg of fluconazole daily for 4 weeks and completely recovered. CONCLUSION: Candida sepsis should be considered in the differential diagnosis of sepsis following CVS.

• Ehrlichiosis associated vasculitis.

  Authors: N Pick, I Potasman, C Strenger, A Keysary, I Schwartz

  Journal of internal medicine. 07/2000; 247(6):674-8.

  OBJECTIVE: To test the hypothesis that some cases of primary vasculitis are caused by ehrlichiosis. DESIGN: A retrospective case study and serological analysis of stored sera. SETTING: UniversityOBJECTIVE: To test the hypothesis that some cases of primary vasculitis are caused by ehrlichiosis. DESIGN: A retrospective case study and serological analysis of stored sera. SETTING: University hospital. SUBJECTS: Fifty-five patients discharged with any type of vasculitis over a 6-year period. MAIN OUTCOME MEASURES: Serology for human monocytic ehrlichiosis, and the human granulocytic ehrlichiosis agent, and polymerase chain reaction (PCR) analysis of biopsy specimens. RESULTS: Three patients (5.5%) had titres of 1 : 128 or higher against E. chaffeensis; none was positive for the human granulocytic ehrlichiosis agent. Skin biopsies of these patients showed lesions compatible with polyarteritis nodosa, allergic purpura and unspecified vasculitis. PCR analysis of the biopsies was unrevealing. CONCLUSIONS: Infection with human monocytic ehrlichiosis may underlie some forms of vasculitis. If confirmed, these findings may help identify patients with vasculitis who would benefit from antibiotic treatment.

• Controlled trial of the effect of cinnamon extract on Helicobacter pylori.

  Authors: Y Nir, I Potasman, E Stermer, M Tabak, I Neeman

  Helicobacter. 07/2000; 5(2):94-7.

  BACKGROUND: Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or preventBACKGROUND: Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or prevent relapse of these diseases. Antimicrobials employed in the eradication of H. pylori are not without adverse effects. Newer treatment modalities, therefore, are required. In vitro studies have shown the effectiveness of cinnamon extract against H. pylori and its urease. In this pilot study, we tested the activity of an alcoholic extract of cinnamon in a group of patients infected with H. pylori. MATERIALS AND METHODS: Fifteen patients (11 women, 4 men) aged 16 to 79 years were given 40 mg of an alcoholic cinnamon extract twice daily for 4 weeks; eight patients aged 35 to 79 (7 women, 1 man) received placebo. The amount of H. pylori colonization was measured by the 13C urea breath test before and after therapy. RESULTS: The mean urea breath test counts in the study and control groups before and after therapy were 22.1 and 23.9 versus 24.4 and 25.9, respectively. The cinnamon extract was well tolerated, and side effects were minimal. CONCLUSIONS: We concluded that cinnamon extract, at a concentration of 80 mg /day as a single agent, is ineffective in eradicating H. pylori. Combination of cinnamon with other antimicrobials, or cinnamon extract at a higher concentration, however, may prove useful.

• Outbreak of Q fever following a safari trip.

  Authors: I Potasman, S Rzotkiewicz, N Pick, A Keysary

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 02/2000; 30(1):214-5.

• Iatrogenic meningitis: an increasing role for resistant viridans streptococci? Case report and review of the last 20 years.

  Authors: L G Yaniv, I Potasman

  Scandinavian journal of infectious diseases. 02/2000; 32(6):693-6.

  Iatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. Cerebrospinal fluid cultures grewIatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. Cerebrospinal fluid cultures grew Streptococcus salivarius partially resistant to penicillin and ceftriaxone. The patient was successfully treated with ceftriaxone and vancomycin and left the hospital with minor sequelae. A literature review of 60 cases revealed the median age of the patients to be 44 y. The median incubation period was 24 h. Most cases occurred after spinal anaesthesia (n = 27), myelography (n = 20) and diagnostic lumbar puncture (n = 5). Organisms were isolated in 52 cases, and streptococcal species were responsible for 33 (63%) of them. An upward trend in resistance of S. viridans isolates is cause for concern and may change empirical treatment strategies. Death was reported in 3 cases (5%) and was associated with Pseudomonas and staphylococcal isolates. The recognition of this entity and the importance of proper infection control measures are underlined.

• Neuropsychiatric problems in 2,500 long-term young travelers to the tropics.

  Authors: I Potasman, A Beny, H Seligmann

  Journal of travel medicine : official publication of the International Society of Travel Medicine and the Asia Pacific Travel Health Association. 01/2000; 7(1):5-9.

  BACKGROUND: The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use haveBACKGROUND: The prevalence and features of travel associated neuropsychiatric problems (NPP) and their relation to previous psychological consultations, antimalarials and recreational drug use have not been adequately studied. METHODS: A two-phase postal and telephone survey has been conducted among 2,500 young travelers to tropical countries. We measured the rate and duration of NPP, characterized their features, and their association with previous psychological profiles, itinerary, type of travel, consumption of recreational drugs, and malaria prophylaxis. RESULTS: First phase: Out of 1,340 respondents, 151 (11.3%) indicated that they had NPP during travel, in contrast with 2.3% who needed psychological consultation before travel (p<.001). Second phase: 117 of 151 responded to the study questionnaire. The mean age of the respondents was 24.4 years, 54.7% were female, and the mean stay abroad was 5.3 months. The most common NPP were sleeping disturbances (52.1%), fatigue (48.7%) and dizziness (39.3%). Thirty-three travelers (2.5%) had severe symptoms, and 16 (1.2%) had symptoms lasting more than 2 months. Seven travelers had pure or mixed depressive symptoms. Consumption of recreational drugs was admitted by 22.2%. Mefloquine was used significantly more often by those who suffered NPP, than by the entire cohort (98.2% vs. 70.7%; p<.001). CONCLUSIONS: Long-term travel to the tropics was associated, in this cohort, with a considerable rate of neuropsychiatric symptoms. The majority of the responding travelers were females, used mefloquine as prophylaxis, and at least one fifth used recreational drugs.

• [Listeria monocytogenes infections--ten years' experience]

  Authors: T Rainis, I Potasman

  Harefuah. 12/1999; 137(10):436-40, 512.

  7 cases of listeriosis were diagnosed here between 1988-1997 (6 in last 3 years), or 2.94/100,000 admissions. 2 elderly patients suffered from meningitis and 2 pregnant women presented with premature7 cases of listeriosis were diagnosed here between 1988-1997 (6 in last 3 years), or 2.94/100,000 admissions. 2 elderly patients suffered from meningitis and 2 pregnant women presented with premature contractions, 1 of whom delivered a premature, infected baby. 2 other patients had fever and gastroenteritis. Listeria monocytogenes was isolated from blood in 4, CSF in 2 and the placenta in 1. It was isolated from those with bacterial meningitis. All patients recovered. Both increased awareness for prevention and better diagnosis are essential to reduce morbidity from this unusual pathogen.

• Isolation of Ureaplasma urealyticum and Mycoplasma hominis from public toilet bowls.

  Authors: I Potasman, A Oren, I Srugo

  Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 02/1999; 20(1):66-8.

  The presence of Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis was explored in 50 public restroom toilet bowls. We used culture, antigen detection, polymerase chain reaction,The presence of Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis was explored in 50 public restroom toilet bowls. We used culture, antigen detection, polymerase chain reaction, and survival assay. Five bowls (10%) were contaminated with at least one organism. U. urealyticum was found in four bowls, M. hominis in three, and C. trachomatis in one. U. urealyticum survived on the toilet rim for up to 2 hours.

• A unique case of mefloquine-induced psoriasis.

  Authors: I Potasman, H Seligmann

  Journal of travel medicine : official publication of the International Society of Travel Medicine and the Asia Pacific Travel Health Association. 10/1998; 5(3):156.

• Helicobacter pylori serostatus in backpackers following travel to tropical countries.

  Authors: I Potasman, A Yitzhak

  The American journal of tropical medicine and hygiene. 04/1998; 58(3):305-8.

  The mode of transmission of Helicobacter pylori is unknown. The seroprevalence of H. pylori and the rate of transmission of feco-oral pathogens in developing countries are both high. Long-termThe mode of transmission of Helicobacter pylori is unknown. The seroprevalence of H. pylori and the rate of transmission of feco-oral pathogens in developing countries are both high. Long-term travelers to these regions, who come from developed countries are thus potentially at increased risk of an infection with this bacterium. We studied the H. pylori serology status before and after travel of 104 backpackers who traveled to tropical countries; 76 medical students who did not leave Israel served as controls. Southeast Asia (70%) and South America (24%) were the major destinations, but the area of travel had no effect on the seroconversion rate. The total time spent abroad was 53 person-years. Thirty six of the travelers and 30 controls were positive at the outset. Seropositivity at entry was significantly associated with being a Sepharadic Jew or having a parent with a peptic ulcer disease. The majority of travelers (86.5%) and controls (92.1%) did not change their serostatus. Four travelers seroconverted, but 10 seroreverted, while three controls seroconverted, and three others seroreverted. No significant association with gastroenteritis was found. Serostatus may have been affected by mefloquine use because none of the four seroconverters, but eight of 10 seroreverters used it as malaria prophylaxis. In vitro studies demonstrated that mefloquine has anti-H. pylori activity. Feco-oral transmission is apparently not an important route of transmission of this organism among travelers.