T M File

Northeast Ohio Medical University, Ravenna, Ohio, United States

Are you T M File?

Claim your profile

Publications (85)386.01 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe a patient with community-acquired pneumonia due to Legionella pneumophila serogroup 6. This patient was found to have bronchoalveolar carcinoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar lavage samples, but no lesions were visible on bronchoscopy. Despite intravenous administration of azithromycin to the patient, repeat culture and polymerase chain reaction showed persistence of Legionella; the isolates remained susceptible to azithromycin. The patient did not respond to 14 doses of daily intravenously administered azithromycin. The poor outcome may have been partially due to the suspected underlying lung malignancy, as shown by cytologic examination, and by a delay in seeking medical attention.
    Clinical Infectious Diseases 07/2001; 32(11):1562-6. · 9.37 Impact Factor
  • T M File
    [Show abstract] [Hide abstract]
    ABSTRACT: When patients with community-acquired pneumonia (CAP) fail to respond after initiation of empirical therapy, it is necessary for the physician to consider a number of possibilities. The diagnosis should be reviewed, with consideration given to both non-infectious and infectious illnesses. If the diagnosis is correct, the failure may relate to three areas: host-related problems, including overwhelming infection and empyema, pathogen-related problems, including infection caused by an unusual or resistant pathogen, and drug-related problems, including inappropriate dose of drug, poor compliance, malabsorption, and drug interactions. A systematic therapeutic approach including a microbiological evaluation to identify the causative pathogen and its susceptibility will help to ensure that an appropriate antimicrobial agent is used.
    Chemotherapy 02/2001; 47 Suppl 4:11-8; discussion 26-7. · 2.07 Impact Factor
  • T M File
    [Show abstract] [Hide abstract]
    ABSTRACT: Respiratory tract infections (RTIs) are the most common, and potentially most severe, of infections treated by health care practitioners. Lower RTIs along with influenza, are the most common cause of death by infection in the United States. Risk factors for pneumonia and other respiratory tract infections include: extremes of age (very young and elderly), smoking, alcoholism, immunosuppression, and comorbid conditions. The microbial cause of RTIs vary depending on the infection (i.e., pneumonia compared with acute bacterial sinusitis), setting (i.e., community-acquired compared with nosocomial), and other factors. The causative pathogens associated with CAP have changed in prevalence over time. Although Streptococcus pneumoniae remains the most common causative pathogen, a number of newer pathogens, such as Chlamydia pneumoniae and sin nombre virus, have been recognized in recent years. The emerging antimicrobial resistance of respiratory pathogens (most notably S. pneumoniae) has also increased the challenge for appropriate management of RTI. An awareness of the epidemiology and cause of specific respiratory infections should optimize care.
    Seminars in Respiratory Infections 10/2000; 15(3):184-94.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the efficacy and safety of azithromycin dihydrate monotherapy with those of a combination of cefuroxime axetil plus erythromycin as empirical therapy for community-acquired pneumonia in hospitalized patients. Patients were enrolled in a prospective, randomized, multicenter study. The standard therapy of cefuroxime plus erythromycin was consistent with the American Thoracic Society, Canadian Community-Acquired Pneumonia Consensus Group, and Infectious Disease Society of America consensus guidelines. The doses were intravenous azithromycin (500 mg once daily) followed by oral azithromycin (500 mg once daily), intravenous cefuroxime (750 mg every 8 hours), followed by oral cefuroxime axetil (500 mg twice daily), and erythromycin (500-1000 mg) intravenously or orally every 6 hours. Randomization was stratified by severity of illness and age. Patients who were immunosuppressed or residing in nursing homes were excluded. Data from 145 patients (67 received azithromycin and 78 received cefuroxime plus erythromycin) were evaluable. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 19% (28/145) and 13% (19/145), respectively. The atypical pathogens accounted for 33% (48/145) of the etiologic diagnoses; Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae were identified in 14% (20/ 145), 10% (15/145), and 9% (13/145), respectively. Clinical cure was achieved in 91% (61/67) of the patients in the azithromycin group and 91% (71/78) in the cefuroxime plus erythromycin group. Adverse events (intravenous catheter site reactions, gastrointestinal tract disturbances) were significantly more common in patients who received cefuroxime plus erythromycin (49% [30/78]) than in patients who received azithromycin (12% [8/67]) (P<.001). Treatment with azithromycin was as effective as cefuroxime plus erythromycin in the empirical management of community-acquired pneumonia in immunocompetent patients who were hospitalized. Azithromycin was well tolerated.
    Archives of Internal Medicine 05/2000; 160(9):1294-300. · 11.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To study the serial radiographic manifestations of Legionnaire's disease from the initial presentation on admission to recovery using strict criteria for the diagnosis of infection. We prospectively studied the chest radiographs of patients hospitalized with a diagnosis of community-acquired pneumonia in Summit County, Ohio between November 1990 and November 1992. Forty-three patients fulfilled strict criteria for legionellosis. The diagnosis of infection was based on the criteria of "definite" diagnosis as defined by the Ohio Community-Based Pneumonia Incidence Study Group report. The criteria included the isolation of the microorganism, the presence of a significant antibody rise, or the presence of Legionella antigen in the urine. Forty of 43 patients had admission radiographs interpreted as compatible with pneumonia. In spite of appropriate antimicrobial therapy, worsening of the infiltrates was found in more than half of the patients within the first week. Twenty-seven patients were observed to have pleural effusion during the course of hospitalization: 10 effusions were found on admission, another 14 developed during the first week, and 3 new effusions were discovered after the first week. Cavitation was found in only one patient. None of the patients had apical involvement. This study confirms previous reports using less stringent etiologic diagnosis criteria that chest radiographic findings in Legionnaire's disease are not specific. Even with appropriate therapy, more than half of the patients will have worsening of the infiltrates during the first week. Pleural effusion is common among our patients, and it is frequently detected during the serial radiographic studies during the first week of hospitalization. Chest radiography in Legionnaire's disease is useful only for the monitoring of disease progression and not for diagnostic purposes. In addition, worsening of infiltrates and pleural effusion are seen in more than half of the patients in spite of appropriate therapy and clinical improvement.
    Chest 03/2000; 117(2):398-403. · 7.13 Impact Factor
  • T M File, J S Tan
    [Show abstract] [Hide abstract]
    ABSTRACT: Necrotizing fasciitis due to Group A streptococcus has been observed with increasing frequency over the past decade. Appropriate management requires rapid recognition of this life-threatening infection and expeditious antimicrobial therapy as well as surgical debridement or excision of tissue.
    Comprehensive Therapy 02/2000; 26(2):73-81.
  • T M File, J S Tan
    [Show abstract] [Hide abstract]
    ABSTRACT: Chlamydia pneumoniae is a common cause of community-acquired pneumonia. At present there is no "gold'' standard for diagnosis and there is no easily accessible means of rapid diagnosis available. The best indication of acute C. pneumoniae infection is a fourfold rise in antibody titer, accompanying a positive polymerase chain reaction or culture. C. pneumoniae is usually associated with nonsevere clinical manifestations but the features will vary depending upon the occurrence as primary or reinfection syndrome, the presence of co-pathogens, or the existence of co-morbid conditions. C. pneumoniae has been described as a cause of severe disease requiring intensive care unit admission. Recommendations for therapy of C. pneumoniae pneumonia include macrolides, tetracyclines, or the new fluoroquinolones.
    Seminars in Respiratory and Critical Care Medicine 02/2000; 21(4):285-94. · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fungal infections in renal transplant recipients are less common than bacterial infections; however, the morbidity from fungal infections is high. There is limited information in the literature concerning post-transplantation cryptococcal infection due to environmental exposure of patients living in high-risk areas. We report three patients who were diagnosed with cryptococcal meningitis after kidney transplantation. Cryptococcal titers prior to transplant surgery were negative in all three patients. These patients all lived in rural areas and demonstrated evidence of environmental exposure leading to subsequent cryptococcal meningitis. All patients had exposure to pigeon and chicken excreta and, after treatment, two patients are alive and well with excellent allograft function. The third patient has marginal renal function but is currently not on dialysis. Early diagnosis is essential for salvage from these potentially lethal infections. Intense headache was a prominent feature in the clinical presentation of our patients, and should signal the need for early sampling and culture of spinal fluid. Meningismus was not present in any of our patients, even when other systemic symptoms were identified. We recommend a high index of suspicion post-transplantation for all patients who may have environmental or occupational exposure to cryptococcus. If infection is detected quickly and treatment instituted promptly, patient recovery and allograft survival are possible. Long-term therapy with fluconazole, a non-nephrotoxic agent, should permit eradication of the infection with preservation of kidney function.
    Transplant Infectious Disease 10/1999; 1(3):213-7. · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The clinical characteristics of 26 patients with community-acquired pneumonia due to Chlamydia pneumoniae as the only identified pathogen who required hospitalization were evaluated. Most patients (18) had reinfection based on serological results. The mean age of the patients was 55 years (38 years, patients with primary infection; 63 years, patients with reinfection), and the gender representation was equal. Generally, illness was mild and associated with limited temperature elevation and nonspecific symptoms. The presence of comorbid illnesses and the requirement of supplemental oxygen therapy were the most common criteria for hospital admission.
    Clinical Infectious Diseases 09/1999; 29(2):426-8. · 9.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To better define the contribution of human parainfluenza viruses (HPIVs) to lower respiratory tract infection in adults, we tested acute- and convalescent-phase serum specimens from hospitalized adults participating in a population-based prospective study of lower respiratory tract infection during 1991-1992. We tested all available specimens from the epidemic seasons for each virus and approximately 300 randomly selected specimens from the corresponding off-seasons for antibodies to HPIV-1, HPIV-2, or HPIV-3. During the respective epidemic season, HPIV-1 infection was detected in 18 (2.5%) of 721 and HPIV-3 infection in 22 (3.1%) of 705 patients with lower respiratory tract infection. Only 2 (0.2%) of 1,057 patients tested positive for HPIV-2 infection. No HPIV-1 infections and only 2 (0.7% of 281 patients tested) HPIV-3 infections were detected during the off-seasons. HPIV-1 and HPIV-3 were among the four most frequently identified infections associated with lower respiratory tract infection during their respective outbreak seasons.
    Clinical Infectious Diseases 08/1999; 29(1):134-40. · 9.37 Impact Factor
  • Article: Legionella.
    TM File, JF Plouffe
    [Show abstract] [Hide abstract]
    ABSTRACT: Since the identification of Legionella two decades ago, a vast amount of information has accumulated concerning the microbiology, clinical manifestations, and therapy of infections due to these organisms. There are now more than 40 species of Legionella identified. The spectrum of legionellosis ranges from asymptomatic infection to serious pneumonia. Two clinical syndromes have been identified: Legionnaire's disease and Pontiac fever. Recent information suggests that the newer macrolides and newer fluoroquinolones are preferred therapy for serious disease.
    Current Infectious Disease Reports 05/1999; 1(1):65-72.
  • T M File
    Current Opinion in Infectious Diseases 05/1999; 12(2):111-3. · 5.03 Impact Factor
  • Joseph F. Plouffe, Thomas M. File
    [Show abstract] [Hide abstract]
    ABSTRACT: Legionella spp. are significant causes of both community-acquired pneumonia and nosocomial pneumonia. More than 40 species of Legionella have now been identified. The spectrum of disease ranges from asymptomatic infection to serious disease, with two specific syndromes identified: Legionnaire's disease and Pontiac fever. Hospital-acquired infection arises from the presence of Legionella in the hospital water supply. The optimal approach for the detection and prevention of nosocomial infection is debatable-whether or not periodic sampling of hospital water systems should be carried out in the absence of clinical cases is controversial. Newer macrolides or newer fluoroquinolone agents are the preferred therapy for serious diseases caused by Legionella.
    Current Opinion in Infectious Diseases 05/1999; 12(2):127-32. · 5.03 Impact Factor
  • J S Tan, T M File
    [Show abstract] [Hide abstract]
    ABSTRACT: Prompt clinical diagnosis and timely treatment are the hallmarks of the proper care of diabetic patients with foot infections. The importance of careful clinical foot examination cannot be overemphasized. When infection is suspected, effort should be made to search for deeper infections, especially osteomyelitis. Numerous imaging techniques are available, but their cost-effectiveness has not been fully determined. Radiography of the foot is less sensitive but can provide useful information at a lower cost. Radio-isotope studies have not yielded consistent results, but the newer techniques deserve attention. Microbiological diagnosis should be attempted using only deep tissue culture, including bone biopsy. The primary aim of treatment of the infected foot is to restore ambulation. Timely surgical intervention and appropriate antimicrobial therapy can reduce the incidence of above-ankle amputation and reduce the length of hospital stay.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 04/1999; 13(1):149-61. · 3.55 Impact Factor
  • Source
    T M File
    [Show abstract] [Hide abstract]
    ABSTRACT: The tremendous therapeutic advantage afforded by antibiotics is being threatened by the emergence of increasingly resistant strains of microbes. Selective pressure favoring resistant strains arises from misuse and overuse of antimicrobials (notably extended-spectrum cephalosporins), increased numbers of immunocompromised hosts, lapses in infection control, increased use of invasive procedures and devices, and the widespread use of antibiotics in agriculture and animal husbandry. Outside the hospital, penicillin-resistant Streptococcus pneumoniae is of greatest concern; recent reports also indicate the appearance of outpatient methicillin-resistant Staphylococcus aureus (MRSA) infections. MRSA is a significant problem in the hospital, as are vancomycin-resistant Enterococcus, oxacillin-resistant S aureus, and multidrug-resistant Gram-negative bacilli. Owing to the high rate of antibiotic use and other risk factors, a person is more likely to acquire an antibiotic-resistant infection in the ICU than anywhere else, either inside or outside the hospital. Responsible antibiotic use and stringent infection-control policies are needed to discourage the development of resistant strains.
    Chest 04/1999; 115(3 Suppl):3S-8S. · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies have used medical record discharge data as coded by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to estimate pneumococcal pneumonia incidence and vaccine efficacy. However, the accuracy of coding data to identify laboratory-confirmed pneumococcal pneumonia is not known. With the use of information collected in Ohio for a community-based pneumonia incidence study, the authors calculated the sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of specific codes for pneumococcal pneumonia among hospitalized patients with community-acquired pneumonia. Sensitivities of the most common ICD-9-CM codes listed in the first five positions for patients with laboratory-confirmed pneumococcal pneumonia were 58.3% (code 481.0, pneumococcal pneumonia), 20.4% (38.0, streptococcal septicemia), 19.2% (38.2, pneumococcal septicemia), 15.0% (518.81, respiratory failure), 14.2% (486.0, pneumonia, organism unspecified), and 11.3% (482.3, streptococcal pneumonia). Using the first five listed ICD-9-CM codes rather than just the first listed code increased sensitivity without causing substantial change in specificity, PPV, and NPV. Sensitivity, PPV, and NPV of individual and groups of codes varied with different case definitions of pneumococcal pneumonia. Incidence and vaccine efficacy studies with the ability to validate diagnoses by medical chart review can use a combination of many ICD-9-CM codes to maximize sensitivity. However, without the ability to review medical charts, researchers must carefully decide which codes would best suit their studies.
    American Journal of Epidemiology 03/1999; 149(3):282-9. · 4.78 Impact Factor
  • Joseph F. Plouffe, Cora McNally, Thomas M. File
    [Show abstract] [Hide abstract]
    ABSTRACT: Noninvasive diagnostic studies, i.e., sputum gram stain, sputum culture, blood culture and antigen detection assays will assist the clinician in the selection of initial antimicrobial therapy in some patients. These tests may be even more valuable in adjusting treatment regimens to prevent the use of broad spectrum antimicrobial agents as routine therapy.
    Infectious Disease Clinics of North America 10/1998; 12(3):689-99, ix. · 2.63 Impact Factor
  • T M File, J S Tan, J F Plouffe
    [Show abstract] [Hide abstract]
    ABSTRACT: Infections caused by M. pneumoniae, C. pneumoniae, and Legionella spp. are important causes of community-acquired pneumonia (CAP). In the past decade, considerable new information has come to light concerning these organisms. Despite this, debate continues concerning the syndromic approach to CAP and the scientific merit of lumping these pathogens together. Because the etiologic diagnosis of these pathogens is established only in a minority of cases, the true prevalence tends to be underestimated. In clinical practice, these pathogens are often empirically treated. More rapid and cost-effective diagnostic techniques are needed so that the clinical course of patients with these infections can be better characterized.
    Infectious Disease Clinics of North America 10/1998; 12(3):569-92, vii. · 2.63 Impact Factor
  • T M File, J S Tan, J R DiPersio
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade the incidence of necrotizing fasciitis due to group A streptococci has increased. Appropriate management of this life-threatening infection requires rapid recognition, immediate antibiotic therapy, and expeditious surgical debridement or excision.
    Cleveland Clinic Journal of Medicine 06/1998; 65(5):241-9. · 3.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of community-acquired pneumonia. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent adult patients. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. The guidelines will be listed on the IDSA home page at http://www.idsociety.org.
    Clinical Infectious Diseases 05/1998; 26(4):811-38. · 9.37 Impact Factor

Publication Stats

2k Citations
386.01 Total Impact Points

Institutions

  • 1986–2001
    • Northeast Ohio Medical University
      • Department of Internal Medicine
      Ravenna, Ohio, United States
  • 1998–1999
    • Summa Health System
      Akron, Ohio, United States
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1979–1999
    • The Ohio State University
      • • Division of Infectious Diseases
      • • Department of Radiology
      • • Division of Hospital Medicine
      Columbus, OH, United States
  • 1996–1997
    • Centers for Disease Control and Prevention
      • Division of Bacterial Diseases
      Druid Hills, GA, United States
  • 1981–1985
    • Akron Children's Hospital
      Akron, Ohio, United States