Emergency Physicians, Internist, Critical Care Specialist, Infectious Disease Specialist (virus, bacteria, parasites), Pulmonologist (lungs)
35 years of experience

Accepting new patients
Maedgen Area
TTU Medical Pavillion
3601 4th St
Lubbock, TX 79430
806-743-3150
Locations and availability (2)

Education ?

Medical School Score Rankings
University of Arizona (1975)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Associations
American Board of Internal Medicine
American Board of Pathology
American Board of Emergency Medicine

Affiliations ?

Dr. Winn is affiliated with 6 hospitals.

Hospital Affilations

Score

Rankings

  • Lubbock Heart Hospital
    Pulmonary Disease
    4810 N Loop 289, Lubbock, TX 79416
    • Currently 3 of 4 crosses
    Top 50%
  • University Medical Center - Lubbock
    Pulmonary Disease
    602 Indiana Ave, Lubbock, TX 79415
    • Currently 2 of 4 crosses
  • Lincoln County Medical Center
  • Darnall Army Community Hospital
    36000 Darnall Loop, Killeen, TX 76544
  • University Medical Center
  • TX Tech Physicians Associates
  • Publications & Research

    Dr. Winn has contributed to 21 publications.
    Title Vaccines and Immunotherapeutics for the Treatment of Malignant Disease.
    Date February 2011
    Journal Clinical & Developmental Immunology
    Excerpt

    The employment of the immune system to treat malignant disease represents an active area of biomedical research. The specificity of the immune response and potential for establishing long-term tumor immunity compels researchers to continue investigations into immunotherapeutic approaches for cancer. A number of immunotherapeutic strategies have arisen for the treatment of malignant disease, including various vaccination schemes, cytokine therapy, adoptive cellular therapy, and monoclonal antibody therapy. This paper describes each of these strategies and discusses some of the associated successes and limitations. Emphasis is placed on the integration of techniques to promote optimal scenarios for eliminating cancer.

    Title Role of the Innate Immune Response and Tumor Immunity Associated with Simian Virus 40 Large Tumor Antigen.
    Date September 2010
    Journal Journal of Virology
    Excerpt

    We examined properties of the innate immune response against the tumor-specific antigen simian virus 40 (SV40) large tumor antigen (Tag) following experimental pulmonary metastasis in naive mice. Approximately 14 days after mKSA tumor cell challenge, expression of inflammatory mediators such as tumor necrosis factor alpha (TNF-alpha), interleukin-2 (IL-2), and RANTES was upregulated in splenocytes harvested from mice, as assessed by flow cytometry and antibody array assays. This response was hypothesized to activate and induce tumor-directed NK cell lysis since IL-2-stimulated NK cells mediated tumor cell destruction in vitro. The necessary function of NK cells was further validated in vivo through selected antibody depletion of NK cells, which resulted in an overwhelming lung tumor burden relative to that in animals receiving a control rabbit IgG depletion regimen. Interestingly, mice achieved increased protection from experimental pulmonary metastasis when NK cells were further activated indirectly through in vivo administration of poly(I:C), a Toll-like receptor 3 (TLR3) agonist. In a separate study, mice receiving treatments of poly(I:C) and recombinant SV40 Tag protein immunization mounted effective tumor immunity in an established experimental pulmonary metastasis setting. Initiating broad-based immunity with poly(I:C) was observed to induce a Th1 bias in the SV40 Tag antibody response that led to successful antitumor responses not observed in animals treated only with poly(I:C) or SV40 Tag. These data have direct implications for immunotherapeutic strategies incorporating methods to elicit inflammatory reactions, particularly NK cell-driven lysis, against malignant cell types that express a tumor-specific antigen such as SV40 Tag.

    Title Cavitary Coccidioidomycosis with Fungus Ball Formation. Diagnosis by Fiberoptic Bronchoscopy with Coexistence of Hyphae and Spherules.
    Date March 1994
    Journal Chest
    Excerpt

    Pulmonary cavitary coccidioidomycosis with fungus ball formation was observed in two individuals with hemoptysis. The first patient had no overt compromise; the second was an insulin-dependent diabetic. In both, fiberoptic bronchoscopy was performed and cultures yielded Coccidioides immitis. The coexistence of spherules and hyphae of C immitis was seen histologically on bronchoscopic biopsy specimen of one cavitary lesion. Specific antifungal therapy and surgical excision were withheld and each patient has done well. This report provides for the first time nonsurgical confirmation that C immitis can produce an intracavitary fungus ball.

    Title Systemic Sporotrichosis Treated with Itraconazole.
    Date October 1993
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Excerpt

    Amphotericin B is recommended for the treatment of systemic infection caused by Sporothrix schenckii. However, this agent is toxic, its use is frequently followed by relapse, and some isolates of S. schenckii are resistant. Recent studies suggest that newer azole compounds, such as itraconazole, are effective in cutaneous and lymphocutaneous sporotrichosis, but data on their efficacy in systemic infections are scarce. We used itraconazole in the sequential treatment of six patients with systemic sporotrichosis: three with bone and joint disease and three with disseminated infection manifested by subcutaneous nodules. In all six cases, symptoms and signs of infection improved, with resolution of subcutaneous nodules, normalization of imaging studies, cessation of wound drainage, and return of joint mobility and function. No toxicity was noted. One patient with disseminated infection had a relapse while receiving 100 mg of itraconazole daily. The average duration of follow-up was 18 months. Thus itraconazole appears promising for the treatment of systemic sporotrichosis. A dose of at least 200 mg/d appears to be needed to prevent relapse.

    Title Varicella Outbreaks in Army Recruits from Puerto Rico. Varicella Susceptibility in a Population from the Tropics.
    Date May 1990
    Journal Archives of Internal Medicine
    Excerpt

    Two outbreaks of varicella consisting of a total of 105 cases occurred in a highly varicella-susceptible population of young adult Army recruits from Puerto Rico enrolled in the Defense Language Institute in San Antonio, Tex, between October 1986 and November 1987. Epidemiologic investigation found a significantly higher risk for enlisted recruits housed in open barracks than for officers housed in private rooms. The attack rate in the first outbreak was 30%, with an estimated attack rate of 71% among susceptible persons. Serologic testing of 810 adult recruits from Puerto Rico for varicella-zoster antibody by means of an enzyme-linked immunosorbent assay procedure found 42% to be seronegative, with no significant difference by sex. The enzyme-linked immunosorbent assay test had a positive predictive value for absence of disease development of 95% in the second outbreak. Serologic test results were successfully used as part of the outbreak control strategy, with a resultant decrease in attack rates to 19% overall and 30% among susceptible persons in the second outbreak. Uniquely susceptible adult populations placed in conditions with high likelihood of infection on exposure are potential candidates for the varicella vaccine after its licensure.

    Title Leptospirosis. Epidemiological Features of a Sporadic Case.
    Date September 1989
    Journal Archives of Internal Medicine
    Excerpt

    Leptospirosis occurred in a 45-year-old man with presumed infection from an exposure to contaminated water at his source of employment. An intensive epidemiological investigation, including serological examination of all family members and pets and cultures on the patient and his family pets (cats and dogs), proved that the leptospiral organism was acquired by the patient's exposure to his dogs. The risk of acquiring infection from dogs that are asymptomatic and vaccinated is emphasized by this report.

    Title Comparative Efficacy and Toxicity of Roxithromycin and Erythromycin Ethylsuccinate in the Treatment of Streptococcal Pharyngitis in Adults.
    Date February 1989
    Journal The Journal of Antimicrobial Chemotherapy
    Excerpt

    Roxithromycin is a novel oxime ether derivative of erythromycin. Previous studies have demonstrated similar in-vitro activity for roxithromycin and erythromycin. Roxithromycin has improved pharmacokinetic properties and may be a useful alternative agent for infections where erythromycin is indicated. We compared the efficacy and toxicity of roxithromycin and erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis in adults. We also assessed compliance with treatment between the two agents. Roxithromycin and erythromycin ethylsuccinate were equally effective in resolving the symptoms and signs of pharyngitis. Erythromycin ethylsuccinate was superior to roxithromycin in achieving microbiological cure (90% vs. 33%, respectively). No differences were observed in toxicity or compliance with treatment between the two agents. Based on this prespective clinical trial, roxithromycin is not considered to be an acceptable alternative agent for acute streptococcal pharyngitis in adults.

    Title Capreomycin Kinetics in Renal Impairment and Clearance by Hemodialysis.
    Date January 1989
    Journal The American Review of Respiratory Disease
    Excerpt

    The single-dose kinetics of capreomycin are described for 12 renal patients and seven healthy control subjects. Creatinine clearances (CrCl) ranged from zero to 121 ml/min. After single-dose intravenous infusions, mean +/- SD capreomycin clearance values (L/kg/h x 10(-2)) were 0.558 +/- 0.160 for the dialysis group (n = 4, CrCl = 1.4 +/- 1.9), 1.77 +/- 0.45 for the moderate renal group (n = 3, CrCl = 25 +/- 5), 2.82 +/- 1.52 for the mild renal group (n = 4, CrCl = 46 +/- 5), and 5.73 +/- 1.54 for the normal renal group (n = 7, CrCl = 109 +/- 11); p less than 0.01, using analysis of variance. The correlation between capreomycin clearance and CrCl was r = 0.90. Hemodialysis cleared clinically significant amounts of capreomycin. These data imply that capreomycin maintenance doses need to be reduced for renal patients.

    Title Cerebrospinal Fluid Abnormalities in Patients Without Aids Who Are Seropositive for the Human Immunodeficiency Virus.
    Date August 1988
    Journal The Journal of Infectious Diseases
    Excerpt

    Lumbar punctures were done on 114 consecutive active duty patients referred for evaluation of positive tests for antibodies to the human immunodeficiency virus (HIV). Eighty-eight percent of these patients appeared to have early HIV infections, as evidenced by intact delayed hypersensitivity, T helper lymphocyte counts greater than 400/mm3, and lack of constitutional symptoms. Forty-four (38.6%) of the patients met our criteria for abnormal cerebrospinal fluid (CSF); another 13 (11.4%) had borderline elevations of nucleated cells or protein and could not be definitely classified as having normal or abnormal CSF. No significant differences existed between the patients with normal and abnormal CSF with regard to age; sex; race; serum FTA-Abs; clinical staging; absolute T helper lymphocyte counts; or cytomegalovirus, Toxoplasma, or Epstein-Barr virus serologies. Seventy-two percent of the patients with abnormal CSF had evidence of possible viral infection of the central nervous system (CNS), as evidenced by increased CSF IgG, increased IgG synthesis rates, or the presence of oligoclonal bands. We found that a significant percentage of asymptomatic patients with apparent early HIV infections have abnormal CSF that is possibly due to CNS involvement by HIV.

    Title Human Curvularia Infections. Report of Five Cases and Review of the Literature.
    Date March 1987
    Journal Diagnostic Microbiology and Infectious Disease
    Excerpt

    Curvularia lunata is a saprobic dematiaceous mould that resides primarily in soil (Ellis, 1966). Reports of human disease caused by this organism are rare but include: endocarditis, brain abscess, skin infections, onychomycosis, keratitis, pneumonia, disseminated disease, mycetoma, allergic bronchopulmonary disease, and one case of sinusitis. Since 1983, we have encountered five cases of paranasal sinusitis due to C. lunata. None of the patients suffered from known immunologic disorders or underlying debilitating diseases. These five cases are presented and the literature of human phaeohyphomycosis caused by Curvularia spp. is reviewed.

    Title Emerging Agents of Phaeohyphomycosis: Pathogenic Species of Bipolaris and Exserohilum.
    Date October 1986
    Journal Journal of Clinical Microbiology
    Excerpt

    Study of numerous living isolates of Bipolaris, Drechslera, Exserohilum, and Helminthosporium spp., as well as a mycological assessment of published case reports of phaeohyphomycosis attributed to these fungi, showed that Bipolaris australiensis, B. hawaiiensis, B. spicifera, Exserohilum longirostratum, E. mcginnisii, and E. rostratum are well-documented pathogens. Conidial shape, septation, and size, hilar characteristics, the origin of the germ tube from the basal cell and, to a lesser extent, from other conidial cells, and the sequence and location of the conidial septa are useful criteria for distinguishing these taxa.

    Title Effect of Folinic Acid on the Capacity of Trimethoprim-sulfamethoxazole to Prevent and Treat Pneumocystis Carinii Pneumonia in Rats.
    Date July 1986
    Journal Antimicrobial Agents and Chemotherapy
    Excerpt

    Daily administration of 1 mg of folinic acid to immunosuppressed rats with incipient or established Pneumocystis carinii pneumonia did not impair the capacity of trimethoprim-sulfamethoxazole to either prevent or treat this disease. These observations constitute the first experimental support for the use of folinic acid to prevent or control cytopenias that occur in patients with Pneumocystis carinii pneumonia who are under trimethoprim-sulfamethoxazole treatment.

    Title Non-01 Vibrio Cholerae Bacteremia--complication of a Leveen Shunt.
    Date May 1986
    Journal American Journal of Clinical Pathology
    Excerpt

    Vibrio cholerae bacteremia occurred in a patient with cirrhosis after placement of a LeVeen shunt. At the time of bacteremia, cultures of peritoneal fluid were negative and fluid dynamics did not suggest spontaneous bacterial peritonitis. Despite apparent successful treatment of the bacteremia, relapse and death occurred with culture positivity of peritoneal fluid for V. cholerae. Simultaneously, blood cultures were positive for Klebsiella pneumoniae. Agglutination studies demonstrated the V. cholerae to be a non-01 strain. Insertion of a LeVeen shunt, which bypasses the hepatic clearance mechanisms, appeared to have allowed bacteremia to occur with this bacterium that is rarely isolated from blood. In patients with LeVeen shunts, bacteremia with noninvasive pathogens may occur, and in coastal areas, Vibrios should be considered when bacteremia occurs.

    Title A Waterborne Outbreak of Cryptosporidiosis in Normal Hosts.
    Date December 1985
    Journal Annals of Internal Medicine
    Excerpt

    In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random telephone survey of 100 of 1791 households in the community identified an attack rate of 34%. The outbreak was traced to contamination of the community water supply, an artesian well. Fecal coliforms were identified in untreated drinking water from the well during July. Stool examinations and serologic tests identified Cryptosporidium as the etiologic agent. Cryptosporidium should be added to the list of waterborne organisms capable of causing outbreaks of gastroenteritis.

    Title Psoriatic Myopathy.
    Date August 1984
    Journal International Journal of Dermatology
    Title Septic Arthritis Involving Capnocytophaga Ochracea.
    Date June 1984
    Journal Journal of Clinical Microbiology
    Excerpt

    Septic arthritis of the knee developed in a 21-month-old child. The causative organism, isolated from two separate arthrocenteses, was identified as Capnocytophaga ochracea morphologically and by biochemical reactions. Previous human infections (bacteremias) have occurred in granulocytopenic hosts with concomitant oral pathology including periodontitis and gingivitis. No abnormalities of oral hygiene were present in this patient, and granulocyte numbers were normal or elevated. Eradication of the infection was accomplished with 8 weeks of antibiotic therapy combined with surgical drainage. Septic arthritis expands the spectrum of infections reported to be caused by Capnocytophaga spp.

    Title Clinical Trial of Cefonicid for Treatment of Skin Infections.
    Date October 1983
    Journal Antimicrobial Agents and Chemotherapy
    Excerpt

    Twenty patients with skin and soft-tissue infections were treated with parenteral cefonicid. Cultures obtained in cellulitis cases from an aspirate of a leading edge of inflammation were positive in 42% of these patients. Pathogens isolated were Staphylococcus aureus (six strains), Proteus mirabilis (one strain), and Streptococcus agalactiae. Adverse effects were pain on intramuscular injection (two patients), rash (one patient), and positive Coombs test (one patient). All side effects were mild and none required discontinuing antibiotic therapy. A single treatment failure occurred in a patient with an undrained perirectal abscess. Cefonicid may be a useful drug in the treatment of skin and soft-tissue infections. The long half-life of cefonicid (4.8 h) is a valuable advantage and may facilitate patient compliance and convenience.

    Title The Clinical Usefulness of Radionuclide Scintigraphy in Suspected Sacro-iliitis: a Prospective Study.
    Date July 1983
    Journal British Journal of Rheumatology
    Excerpt

    The ability of quantitative sacro-iliac scintigraphy (QSS) to detect sacro-iliac joint (SIJ) disease was compared to that of standard radiographs in a prospective study of 26 patients with low back pain suggestive of spondylitis. Of 52 SIJs studied, QSS was abnormal in 21 (40%) and radiographs positive in 23 (44%) (p = 0.47). QSS was abnormal in only 11 of the 23 (48%) radiographically abnormal SIJs. Conversely, 29 radiographically equivocal or negative SIJs yielded positive scintigraphs in ten (34%). Although QSS in general is no more sensitive than standard radiographs, it may allow detection of radiographically inapparent sacro-iliitis in carefully selected patients.

    Title Oral Pulse Prednisone Therapy in the Treatment of Hbsag Negative Chronic Active Hepatitis.
    Date December 1982
    Journal Gastroenterology
    Excerpt

    A young woman with hepatitis B surface antigen negative chronic active hepatitis and hypergammaglobulinemia was treated successfully with oral pulse steroid therapy consisting of prednisone, 90 mg/day, given in repeated 3--5-day courses at 3--4-wk intervals. This approach, which is hypothetically founded on the ability of steroids to cause prolonged inhibition of immunoglobulin G synthesis and proposed mechanisms of hepatocellular damage in chronic active hepatitis, permitted complete clinical, chemical, and histologic remission without morbidity. Oral pulse prednisone therapy deserves further study as a possible adjunct or alternative to existing methods of managing hepatitis B surface antigen negative chronic active hepatitis associated with hypergammaglobulinemia.

    Title Anaerobic Bacterial Infection and Xanthogranulomatous Pyelonephritis: a Case Report.
    Date December 1982
    Journal The Journal of Urology
    Excerpt

    A young man presented with a history of uncorrected ureteropelvic junction obstruction 18 months in duration and clinical acute pyelonephritis. Retrograde pyelography showed unilateral pyonephrosis and cultures of purulent drainage proximal to the ureteropelvic junction revealed predominantly anaerobic bacteria and no aerobic gram-negative bacilli. Subsequent nephrectomy established a diagnosis of xanthogranulomatous pyelonephritis. Nephrectomy in combination with intensive antimicrobial therapy resulted in recovery. The contribution of anaerobic bacteria in the pathogenesis of xanthogranulomatous pyelonephritis is unknown. Anaerobic culture of urine and excised tissue in these patients may be indicated.

    Title Observations Relating to an Inter-hospital Outbreak of Methicillin-resistant Staphylococcus Aureus: Role of Antimicrobial Therapy in Infection Control.
    Date March 1982
    Journal Infection Control : Ic
    Excerpt

    Clinical, bacteriologic, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p less than 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p less than 0.01), but, in contrast to previous studies, this was not a significant risk factor (p greater than 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p less than 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus.

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