Internists, Infectious Disease Specialist (virus, bacteria, parasites)
41 years of experience

Maedgen Area
Texas Tech University
3601 4th St
Lubbock, TX 79430
806-433-3150
Locations and availability (1)

Education ?

Medical School Score
University of Kansas (1969)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Appointments
Texas Tech Univ School Of Medicine
PROFESSOR
Associations
American Board of Internal Medicine

Affiliations ?

Dr. Kimbrough is affiliated with 7 hospitals.

Hospital Affilations

Score

Rankings

  • University Medical Center - Lubbock
    602 Indiana Ave, Lubbock, TX 79415
    • Currently 2 of 4 crosses
  • TX Tech Physicians Associates
  • Lincoln County Medical Center
  • Univ Med Ctr
  • University Medical Center
  • University Medical Center Health System
  • University Med Ctr, Lubbock, Tx
  • Publications & Research

    Dr. Kimbrough has contributed to 35 publications.
    Title Organizing Pneumonia and Pulmonary Eosinophilic Infiltration Associated with Daptomycin.
    Date May 2007
    Journal The Annals of Pharmacotherapy
    Excerpt

    OBJECTIVE: To report a case of organizing pneumonia with pulmonary eosinophilic infiltrates in a patient receiving daptomycin. CASE SUMMARY: An 84-year-old man developed bilateral, irregularly shaped nodules and infiltrates in the mid and peripheral lung and multiple mediastinal lymph nodes following treatment with intravenous daptomycin for infection of his left knee prosthesis. His other symptoms included decreased appetite, weight loss (6.8 kg over 4-6 wk), malaise, and generalized weakness after 4 weeks of daptomycin therapy. Transthoracic needle biopsy revealed organizing pneumonia with scattered eosinophils. His symptoms and results of computed tomography (CT) scan improved in the month following discontinuation of daptomycin. The Naranjo probability scale indicated a probable reaction to daptomycin. DISCUSSION: Pulmonary reactions have been reported with numerous drugs and have a wide range of clinical and radiographic presentations. Clinical trials have shown that daptomycin is well tolerated and has an adverse effect profile similar to that of vancomycin and the semisynthetic penicillins. This case report suggests that chronic use of daptomycin caused organizing pneumonia with eosinophilic infiltrates in a patient treated for an infected knee prosthesis. A definite mechanism for this reaction is not known. We speculate that the chronic administration of daptomycin allowed drug accumulation in surfactant in the alveolar spaces. This may result in higher concentrations of drug near the alveolar epithelial surface, which could injure the epithelium, resulting in organizing pneumonia. CONCLUSIONS: Development of new pulmonary infiltrates in patients treated with chronic daptomycin therapy should alert healthcare workers to this potential association.

    Title Pseudallescheria Boydii Keratitis.
    Date January 2007
    Journal Scandinavian Journal of Infectious Diseases
    Excerpt

    A case of Pseudallescheria boydii keratitis is presented. The patient was successfully treated with topical natamycin and systemic itraconazole in conjunction with penetrating keratoplasty, leading to visual acuity of 20/40.

    Title Human West Nile Virus Neuroinvasive Disease in Texas, 2003 Epidemic: Regional Differences.
    Date January 2007
    Journal Annals of Epidemiology
    Excerpt

    PURPOSE: Arboviral diseases, such as West Nile virus (WNV) epizootics, tend to be geographically unique because of the biomes that support the vector(s) and reservoir host(s). Understanding such details aids in preventive efforts. We studied the 2003 epidemic of human West Nile neuroinvasive disease (WNND) in Texas because it initially appeared that incidence was not uniform across regions of the state. METHODS: The epidemic was described by age, sex, and region of residence. These variables were used to compare age-specific incidence, standardized cumulative incidence, and age-adjusted relative risk (RR). We verified case data and used routine software, with population estimates from the US Census Bureau. RESULTS: Regardless of sex, risk increased with age. Males had the greater risk (RR, 1.69); however, males aged 5 to 17 years had the greatest RR. Of the five regions compared, two posed more (RRs, 7.98 and 2.14) and one posed less (RR, 0.40) risk than the remainder of the state. Proportions of Culex vector species differed significantly between regions. CONCLUSIONS: During 2003, the risk for WNND varied considerably across Texas. This suggests that various risks for WNV infection deserve additional research for preventive interventions to be regionally appropriate and effective.

    Title Pulmonary Cholera Due to Infection with a Non-o1 Vibrio Cholerae Strain.
    Date October 2006
    Journal Journal of Clinical Microbiology
    Excerpt

    We present 2 cases of primary pulmonary non-O1 Vibrio cholerae infection. We believe that these are the first documented cases of primary pulmonary infection due to this organism from a freshwater source.

    Title Candida Glabrata Endophthalmitis Treated Successfully with Caspofungin.
    Date August 2006
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Excerpt

    A 39-year-old man with Candida glabrata endophthalmitis was successfully treated with a 28-day course of intravenous caspofungin. Presence of underlying renal insufficiency and infection with a drug-resistant strain precluded use of amphotericin B or fluconazole. Intravitreal administration of antifungals and vitrectomy were not required. The role of caspofungin in Candida endophthalmitis is discussed.

    Title Fatal Adenovirus Serotype-5 in a Deceased-donor Renal Transplant Recipient.
    Date July 2006
    Journal Transplant Infectious Disease : an Official Journal of the Transplantation Society
    Title Bartonella Quintana Associated Neuroretinitis.
    Date April 2006
    Journal Scandinavian Journal of Infectious Diseases
    Excerpt

    We report an observational case of Bartonella quintana-associated neuroretinitis. The patient had a positive IgM IFA titer for Bartonella quintana early in the disease. After treatment, the neuroretinitis and IgM resolved. Given the patient's history, symptoms, response to treatment, and IgM course, we believe his neuroretinitis was secondary to Bartonella quintana.

    Title Cellulitis Caused by Cryptococcus Neoformans in a Lung Transplant Recipient.
    Date September 2005
    Journal The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
    Title Aspergillus Terreus Endophthalmitis.
    Date September 2005
    Journal Scandinavian Journal of Infectious Diseases
    Excerpt

    We report a case of Aspergillus terreus endophthalmitis and review the 4 previously reported cases. Immunosuppression, intravenous drug use, intraocular surgery or trauma, and a compatible clinical picture should raise suspicion of the diagnosis. This species often exhibits resistance to amphotericin B and outcomes are poor despite current therapies.

    Title Endophthalmitis Caused by Non-perfringens Clostridium Species.
    Date December 2004
    Journal Scandinavian Journal of Infectious Diseases
    Excerpt

    The role of other non-perfringens Clostridium species in endophthalmitis infections has not been analyzed. We describe a case of non-perfringens Clostridium endophthalmitis and review prior cases in the literature. Fulminant clinical presentations and poor visual outcomes are the rule, but a combined aggressive medical and surgical approach may conserve vision.

    Title Salvage of a Prosthetic Knee Joint Infected with Resistant Pneumococcus. A Case Report.
    Date November 2004
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Population Patterns and Antimicrobial Resistance of Aeromonas in Urban Playa Lakes.
    Date October 2004
    Journal Canadian Journal of Microbiology
    Excerpt

    Bacteria belonging to the genus Aeromonas are indigenous to aquatic environments. Once regarded as unimportant human pathogens, reports of opportunistic infections caused by these organisms have appeared increasingly in the medical literature. To estimate the potential for human infection by Aeromonas where limited water resources are being used intensively, we studied the spatial and temporal variation and incidence of antimicrobial resistance among environmental isolates of Aeromonas from two urban playa lakes in Lubbock, Texas. Aeromonas population densities varied seasonally, with the highest densities occurring from mid-April to late October. The greatest range of densities was 100-fold, from 2.50 to 255.17 colony-forming units per 0.1 mL of water sample. Densities also varied with water depth, although the variation did not display a consistent pattern. One hundred fifty-one Aeromonas isolates were divided into 10 species or subspecies groups by using the BIOLOG identification system. Nine isolates displayed resistance to co-trimoxazole, tetracycline, and cefuroxime, and none was resistant to more than one of these antimicrobial agents. In summary, the results of this study showed that the densities of Aeromonas peak in the late spring and again in late summer, times when human activity around the playa lakes is also high. Thus, we infer that human exposure to these potential pathogens varies seasonally. Compared to other published studies, the incidence of antimicrobial-resistant Aeromonas is relatively low in urban playa lakes in Lubbock, Texas. Nevertheless, resistant organisms were detected.

    Title Deep Sternal Wound Infection Caused by Group G Streptococcus After Open-heart Surgery.
    Date June 2004
    Journal The American Journal of the Medical Sciences
    Excerpt

    We report the first case of deep sternal wound infection caused by group G Streptococcus after open-heart surgery. The patient's clinical presentation was nonspecific and his diagnosis was delayed. Surgical debridement and a 4-week course of intravenous antibiotics consisting of sequential penicillin plus gentamicin/ceftriaxone led to recovery. Group G Streptococcus should be suspected as an important postoperative pathogen.

    Title Use of Intravenous Polymyxin B During Continuous Venovenous Hemodialysis.
    Date June 2004
    Journal European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
    Excerpt

    Described here is the case of a 23-year-old male with Acinetobacter baumannii sepsis and acute renal failure requiring continuous venovenous hemodialysis treated successfully with intravenous polymyxin B. The drug was administered as a loading dose of 2.5 mg/kg, followed by 2 doses of 1 mg/kg on days 4 and 8, then 0.8 mg/kg daily to complete a 24-day course. A discussion of dosing recommendations for polymyxins in dialysis is presented.

    Title Fatal Infection Caused by Francisella Tularensisin a Neutropenic Bone Marrow Transplant Recipient.
    Date May 2003
    Journal Annals of Hematology
    Excerpt

    Francisella tularensis is one of the most infectious pathogenic bacteria known. Even though immunity against this organism is thought to be primarily T cell mediated, some evidence suggests that neutrophils may also play an important protective role. We report a case of tularemia in a neutropenic bone marrow transplant recipient that sheds light on the importance of neutrophils in protection against this infection and review clinical aspects of this fascinating infection emphasizing areas of interest for immunocompromised hosts.

    Title Cd4+ T Lymphocytopenia with Disseminated Hpv.
    Date April 2003
    Journal Journal of Cutaneous Pathology
    Excerpt

    BACKGROUND: There have been several reports of HIV-negative patients with chronic idiopathic CD4+ T lymphocytopenia, the diagnostic criteria for which are: depressed numbers of circulating T lymphocytes (less than 300/ micro l or less than 20%) on more than one occasion; no laboratory evidence of HIV-1 or HIV-2 infection; and the absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T lymphocytes. METHODS: We report a patient with disseminated human papillomavirus infection associated with idiopathic CD4+ T-cell lymphocytopenia. A 50-year-old woman presented to the dermatology clinic with a 10-year history of widespread verrucae involving the skin and the cervix. RESULTS: Biopsy from the arm revealed a common wart. PCR analysis performed from the paraffin-embedded block was strongly positive for HPV type 2. Other HPV types (including EV-associated HPV 5, 8, 14, 15, 17) were not found. Further laboratory work up revealed T-cell lymphocytopenia, with an absolute CD4 count of 21. HIV tests were repeatedly negative. She was treated with interferon A 8 million units SQ three times per week with partial improvement. The patient underwent a hysterectomy for cervical dysplasia and a vulvectomy for vulvar intraepithelial neoplasia. She developed small-cell lung carcinoma and died. CONCLUSIONS: The diagnosis of idiopathic CD4+ T-cell lymphocytopenia should be considered in any patient with widespread viral, fungal, or mycobacterial infection whose HIV test is negative, and appropriate evaluation of the absolute CD4+ counts should be performed.

    Title Hand Infections in Patients with Diabetes Mellitus.
    Date February 2002
    Journal Orthopedics
    Excerpt

    Fifty diabetic patients with hand infections were studied retrospectively. The cause of infection varied, and the infections were divided into two groups: superficial infections and abscesses. The amputation rate was 14%. Only patients who presented with an abscess required amputation, and of those patients with abscesses, 17.5% required amputation. Eighteen of 38 cultured infections were polymicrobial, 4 contained Enterococcus, 11 contained gram-negative bacteria, and 3 contained anaerobic organisms. Bacteriologic culture analysis initiated a two-drug protocol: ampicillin with sulbactam (Unasyn; Pfizer, New York, NY) or piperacillin with tazobactam (Zosyn; Lederle, Pearl River, NY) and gentamicin (renal adjusted).

    Title Infections Caused by Kluyvera Species in Humans.
    Date December 2001
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Excerpt

    Kluyvera is a relatively newly described genus in the family Enterobacteriaceae that infrequently causes infections in humans. The organism has been isolated from various clinical specimens, but its significance has not been clearly established. In fact, it has been regarded alternatively as saprophytic, opportunistic, or pathogenic. Since the redefinition of this genus in 1981, case reports of diverse clinical infections occurring under various host conditions have been published. Here we present a critical review of all Kluyvera infections reported in the literature, along with our experience involving 5 additional cases. Most patients received prompt antimicrobial treatment on the basis of susceptibility testing, and overall the clinical outcomes were good. Antimicrobial agents active against most Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. In contrast, the resistance to ampicillin, extended-spectrum penicillins, and first- and second-generation cephalosporins is significant. Kluyvera is a potentially virulent pathogen that deserves aggressive treatment designed with an awareness of the organism's antimicrobial resistance patterns.

    Title Haemophilus Influenzae Osteomyelitis in Adults: a Report of 4 Frontal Bone Infections and a Review of the Literature.
    Date September 2001
    Journal Scandinavian Journal of Infectious Diseases
    Excerpt

    Haemophilus influenzae occasionally causes hematogenous long-bone osteomyelitis in children. In adults, however, bone infections caused by this organism are extremely rare. We report four adult cases of H. influenzae frontal bone osteomyelitis and review 12 cases from the literature.

    Title Salmonella Enteritidis Brain Abscess: Case Report and Review.
    Date March 2001
    Journal Clinical Neurology and Neurosurgery
    Excerpt

    Intracranial infections are unusual manifestations of salmonellosis. Even with adequate medical and surgical interventions these infections are often associated with significant morbidity and mortality. We report a case of brain abscess caused by Salmonella enteritidis associated with a brain neoplasm and review previous reports in the literature.

    Title Anaerobic Bacteremia in a Neutropenic Patient with Oral Mucositis.
    Date April 2000
    Journal The American Journal of the Medical Sciences
    Excerpt

    An increasing number of anaerobic bloodstream infections in neutropenic cancer patients have been reported in the last decade. The type of anaerobes isolated from most of these patients suggests an oral source of infection. We describe a case of anaerobic bacteremia in a neutropenic patient with oral mucositis that highlights the importance of considering these organisms when selecting empiric prophylactic or therapeutic antimicrobial regimens, especially in the setting of periodontal disease or oral mucositis.

    Title Infective Endocarditis Caused by Staphylococcus Hominis After Vasectomy.
    Date September 1998
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Title Mucormycotic Osteolytic Rib Lesion Presenting As Subacute Pleural Effusion.
    Date October 1996
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Title Borreliosis As a Cause of Fever in a Woman Who Recently Returned from Saudi Arabia.
    Date March 1996
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
    Title The Good Gift: a Comparison of the Eli Lilly Presentation Copies of Aequanimitas.
    Date October 1995
    Journal Journal of the South Carolina Medical Association (1975)
    Excerpt

    The Eli Lilly Pharmaceutical Company of Indianapolis, Indiana distributed some 150,000 copies of the third edition of Sir William Osler's Aequanimitas to graduating medical students between 1932 and 1953. Bibliophiles have considered these volumes identical. However, there were at least seven different printings in English and one in Spanish and one in Portuguese. The size of the book and type of paper changed over the years. The title page, spine information, and printing information also changed. A congratulatory letter from Eli Lilly and Company was placed in the front of each book. These letters have many differences. Thus, the volumes are not identical and the recognition of these differences opens a new field for research and collecting.

    Title The Failure of Ciprofloxacin to Prevent the Progression of Streptococcus Pneumoniae Infections to Meningitis.
    Date January 1992
    Journal Missouri Medicine
    Title Infectious Complications with Respiratory Pathogens Despite Ciprofloxacin Therapy.
    Date August 1991
    Journal The New England Journal of Medicine
    Title Failure of Treatment with Teicoplanin at 6 Milligrams/kilogram/day in Patients with Staphylococcus Aureus Intravascular Infection. The Infectious Diseases Consortium of Oregon.
    Date May 1991
    Journal Antimicrobial Agents and Chemotherapy
    Excerpt

    Patients with blood cultures positive for gram-positive cocci were enrolled in a prospective randomized double-blind comparative trial of vancomycin at 15 mg/kg every 12 h versus teicoplanin at 6 mg/kg every 12 h for three doses and then 6 mg/kg every 24 h. A total of 54 patients were randomized, and 40 were evaluable. Of the 40, 9 had infection of indwelling vascular catheters. Four infections were due to Staphylococcus aureus, and five were due to Staphylococcus epidermidis. In concert with catheter removal, all patients were treated successfully, regardless of which drug they were taking. Of 31 patients without an indwelling catheter, 19 were infected with S. aureus, and 12 of the 19 had either endocarditis or mycotic aneurysm. Six of eight patients given teicoplanin failed treatment, as opposed to one of four patients given vancomycin (P = 0.14). Of greater concern, four of four patients with left-sided endocarditis or mycotic aneurysm failed to recover when given teicoplanin, as opposed to one of three patients given vancomycin (P = 0.07). Although not quite statistically significant, the unexpectedly high number of treatment failures with teicoplanin resulted in a decision to discontinue patient enrollment. It is suggested that future trials explore the efficacy of larger doses of teicoplanin.

    Title Appropriateness of Antibiotic Therapy in Long-term Care Facilities.
    Date November 1987
    Journal The American Journal of Medicine
    Excerpt

    The objective of this study was to examine the appropriateness of antibiotic therapy in nursing homes. Information was abstracted from infection control reports and patients' charts for a three-month period at two nursing homes in Portland, Oregon. A panel of two board-certified infectious disease specialists and one hospital pharmacist reviewed the information and rated the appropriateness of each prescription using a previously developed scale. Among the 120 infections, treatment was rated as appropriate in 49 percent, as inappropriate in 42 percent, and as unjustified in 9 percent. Cephalosporins received the lowest percent of appropriate ratings (27 percent). The primary reason for an inappropriate rating was that a more effective drug was recommended for empiric therapy of gram-negative bacillary infections. These bacteria are often resistant to oral antibiotics. There were no significant differences in appropriateness by type of organism, infection site, or clinical outcome. Physician education and the development of systems and guidelines for optimal management in this population are appropriate actions for the future.

    Title The Use of Cefotaxime in a Community Hospital.
    Date April 1984
    Journal Drug Intelligence & Clinical Pharmacy
    Excerpt

    The use of cefotaxime was monitored to evaluate the appropriateness and cost of its use. This was done by chart review and physician questionnaire. Of 57 patients reviewed, 19 were treated empirically for specific established infections; 19 for sepsis without an identified source; 3 for infections with a known pathogen; and 16 for surgical prophylaxis. In the majority of patients treated empirically for specific infection or sepsis, the use of cefotaxime was judged appropriate by infectious disease consultants, while for surgical prophylaxis, it usually was judged inappropriate. The average charge for cefotaxime was +396 per course vs. +318 for antibiotics commonly used before cefotaxime became available. When used alone, cefotaxime was less expensive to the patient than a combination of antibiotics in 22 of 29 cases. We concluded that cefotaxime was used appropriately for empiric therapy without increasing costs greatly.

    Title Group B Streptococcal Meningitis Appearing As Acute Deafness in an Adult.
    Date February 1984
    Journal Archives of Neurology
    Excerpt

    A case of group B streptococcal meningitis developed in a previously healthy adult. The group B streptococcus may be underrecognized as a pathogen in human disease. Survival is good after appropriate therapy, with only six fatalities in 33 cases reported in the literature. However, our patient showed the unusual neurologic complication of bilateral deafness in group B meningitis in adults.

    Title Stability of Single and Combination Antimicrobial Agents in Various Peritoneal Dialysates in the Presence of Insulin and Heparin.
    Date December 1983
    Journal American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    Excerpt

    The antimicrobial activity of ampicillin, azlocillin, cefotaxime, cephapirin, clindamycin, mezlocillin, nafcillin, piperacillin, tobramycin, and vancomycin was tested in peritoneal dialysate at room temperature for 24 hours and 48 hours. All of the antimicrobial agents were active at 24 hours. The bioactivity of cefotaxime, nafcillin, and vancomycin declined 15% to 20% after 48 hours (P less than 0.001). The addition of heparin or insulin did not affect the activity of any of the study drugs. The combination of cephapirin and tobramycin remained bioactive for 24 hours at room temperature and 35 degrees C. The preparation of drug-dialysate solution every one to two days is feasible for the treatment of peritonitis in patients on continuous ambulatory or continuous cycled peritoneal dialysis.

    Title Moxalactam and Hemorrhage.
    Date July 1983
    Journal Annals of Internal Medicine
    Title Q Fever Endocarditis in the United States.
    Date October 1979
    Journal Annals of Internal Medicine
    Excerpt

    A patient with Q fever endocarditis, which is almost unknown in the United States, was followed for a total of 32 months; the study was begun 3 1/2 months before aortic valve replacement. Diagnosis was confirmed by serology, visualization of Coxiella burnetii in excised aortic valve tissue by direct and immunofluorescence staining, and isolation of C. burnetii from aortic valve tissue. Serum antibodies against phase I and phase II antigens of C. burnetii were identified. Almost all phase I and phase II antibodies were IgG. These findings are compared with those in an uncomplicated case of acute Q fever. New findings on the immune response to chronic Q fever are presented.

    Title Congenital Gastric Diverticulum As a Cause of Massive Hemorrhage.
    Date March 1974
    Journal The American Journal of Digestive Diseases

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