1
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Abstract
Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.
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Affiliation(s)
- A Ansari
- Department of Orthopaedics, University College Hospital, Grafton Way, London, United Kingdom
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2
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Abstract
Purpose To report a case of bilateral endogenous endophthalmitis due to group G Streptococcus after a dental procedure. METHODS Case report of a 69-year-old woman who presented with pain, decreased vision, bilateral uveitis, and a unilateral hypopyon 1 week after treatment for an abscessed tooth. Results Bilateral endophthalmitis was diagnosed, and group G Streptococcus was cultured from the vitreous samples. CONCLUSIONS To our knowledge, this is the second reported case of endogenous endophthalmitis following a dental procedure. Furthermore, it was due to group G Streptococcus, which is a rare cause of this condition.
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Affiliation(s)
- N G Ziakas
- Department of Ophthalmology, Aristotle University of Thessaloniki, Greece.
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3
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Affiliation(s)
- O Awotesu
- Barts & The London School of Medicine & Dentistry, London, UK
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4
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Abstract
Endovascular treatment of aortic aneurysms has gained widespread popularity in recent years. Stent grafts have emerged as another option in the surgeon's armamentarium in the treatment of aneurysmal disease. The infectivity of endovascular grafts and therapy for associated graft infections is unknown. Aortic graft infections have the potential for disastrous complications. This report presents a 72-year-old woman with persistent fever and an infected aortic stent graft in the early postoperative period.
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Affiliation(s)
- Timothy Pringle
- Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, OH, USA.
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5
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Arifi AA, Koehler A, Hwong TMT, Wan S, Wan IYP, Yim APC. Staphylococcus Aureus Pancarditis Complicated by a Left Ventricular Pseudoaneurysm. Asian Cardiovasc Thorac Ann 2016; 12:86-8. [PMID: 14977752 DOI: 10.1177/021849230401200122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute septic pancarditis is a life threatening but fortunately rare condition. We report a case of this condition in a young 20-year-old female patient with an early complication of mitral valve destruction and a late complication of a left ventricular pseudoaneurysm formation.
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MESH Headings
- Adult
- Aneurysm, False/complications
- Aneurysm, False/diagnosis
- Aneurysm, False/surgery
- Anti-Bacterial Agents
- Combined Modality Therapy
- Drug Therapy, Combination/therapeutic use
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/drug therapy
- Female
- Follow-Up Studies
- Heart Aneurysm/complications
- Heart Aneurysm/diagnosis
- Heart Aneurysm/surgery
- Heart Valve Prosthesis
- Heart Ventricles
- Humans
- Mitral Valve Stenosis/complications
- Mitral Valve Stenosis/diagnosis
- Mitral Valve Stenosis/surgery
- Risk Assessment
- Shock, Septic/complications
- Shock, Septic/diagnosis
- Shock, Septic/therapy
- Staphylococcal Infections/complications
- Staphylococcal Infections/diagnosis
- Staphylococcus aureus/isolation & purification
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Ahmed A Arifi
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People's Republic of China.
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6
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Affiliation(s)
- J Weber
- Robert Bosch Hospital, Teaching Hospital, Eberhard Karls University of Tübingen, Department of Internal Medicine, Stuttgart, FRG
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7
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Przechera M, Bengel D, Risler T. Pharmacokinetics of imipenem/cilastatin during continuous arteriovenous hemofiltration. Contrib Nephrol 2015; 93:131-4. [PMID: 1802563 DOI: 10.1159/000420202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Przechera
- Department of Nephrology, University of Tübingen, FRG
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8
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9
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Abstract
A 42-year old Italian male with type 2 diabetes and HCV-related chronic hepatitis spent 6 months in Thailand. After his return in June 2002 he was admitted to the Infectious Diseases Unit of the Hospital of Livorno (Italy) because of fever, chest pain and skin abscesses in the legs. Chest X-rays and CT scan revealed multiple bilateral cavitary lesions in the lungs. Ultrasonography and CT scan showed numerous subcentimetric spleen abscesses. Burkholderia pseudomallei was isolated from the cutaneous lesions and sputum and thus melioidosis was diagnosed. A 6-week course of i.v. ceftazidime plus oral doxycycline was given during the acute phase of the illness. The in vitro susceptibility testing showed that long-term (20 weeks) antimicrobial therapy with doxycycline and moxifloxacin was required. Complete resolution of pulmonary and spleen lesions was obtained within 6 weeks of therapy and of cutaneous abscesses in 10 weeks. No significant side effects were noted during the follow-up period using this scheme of antimicrobial therapy.
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Affiliation(s)
- O Maccanti
- Infectious Diseases, Livorno Hospital, Livorno, Italy.
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10
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Abstract
The clinical and microbiological efficacy, as well as the tolerability of the amoxicillin/sulbactam combination as empiric treatment for complicated community-acquired pneumonia (CCAP) were evaluated in children from 3 months to 15 years with CCAP who were randomized 1:1 to receive either amoxicillin/sulbactam or cefuroxime. Of 234 patients hospitalized with CCAP in the study period (June, 1999-April, 2002), 62 patients qualified for the study: 32 received amoxicillin/sulbactam and 30 cefuroxime. Two were excluded. Demographic and clinical data showed that both groups were comparable at entry. One etiologic agent was identified in 55% of the patients, with Streptococcus pneumoniae being the most frequent. After treatment, the days of fever, duration of intravenous treatment, and hospitalization stay were similar in both groups. Overall favorable clinical responses were comparable: 97% for amoxicillin/sulbactam vs 100% for the comparative therapy. There was good tolerance to both drugs. Amoxicillin/sulbactam produced a satisfactory therapeutic outcome similar to that of cefuroxime for treatment of CCAP, and may be an appropriate choice for the treatment of this serious pediatric infection.
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Affiliation(s)
- D Lovera
- Department of Pediatrics, Instituto de Medicina Tropical, Mexico
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11
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Abstract
Respiratory tract infection with eventual respiratory failure is the major cause of morbidity and mortality in cystic fibrosis (CF). Infective exacerbations need to be treated promptly and effectively to minimize potentially accelerated attrition of lung function. The choice of antibiotic depends on in vitro sensitivity patterns. However, physicians treating patients with CF are increasingly faced with infection with multidrug-resistant isolates of Pseudomonas aeruginosa. In addition, innately resistant organisms such as Burkholderia cepacia complex, Stenotrophomonas maltophilia and Achromobacter (Alcaligenes) xylosoxidans are becoming more prevalent. Infection with methicillin-resistant Staphylococcus aureus (MRSA) is also a problem. These changing patterns probably result from greater patient longevity and increased antibiotic use for acute exacerbations and maintenance care. Multidrug-resistant P. aeruginosa infection may be treated successfully by using two antibiotics with different mechanisms of action. In practice antibiotic choices have usually been made on a best-guess basis, but recent research suggests that more directed therapy can be achieved through the application of multiple-combination bactericidal testing (MCBT). Aerosol delivery of tobramycin for inhalation solution achieves high endobronchial concentrations that may overcome bacterial resistance as defined by standard laboratory protocols. Resistance to colistin is rare and this antibiotic should be seen as a valuable second-line drug to be reserved for multidrug-resistant P. aeruginosa. The efficacy of new antibiotic groups such as the macrolides needs to be evaluated.CF units should adopt strict segregation policies to interrupt person-to-person spread of B. cepacia complex. Treatment of panresistant strains is difficult and often arbitrary. Combination antibiotic therapy is recommended, usually tobramycin and high-dose meropenem and/or ceftazidime, but the choice of treatment regimen should always be guided by the clinical response.The clinical significance of S. maltophilia, A. xylosoxidans and MRSA infection in CF lung disease remains uncertain. If patients show clinical decline and are chronically colonized/infected with either of the former two pathogens, treatment is recommended but efficacy data are lacking. There are defined microbiological reasons for attempting eradication of MRSA but there are no proven deleterious effects of this infection on lung function in patients with CF. Various treatment protocols exist but none has been subject to a randomized, controlled trial. Multidrug-resistant microorganisms are an important and growing issue in the care of patients with CF. Each patient infected with such strains should be assessed individually and antibiotic treatment planned according to in vitro sensitivity, patient drug tolerance, and results of in vitro studies which may direct the physician to antibiotic combinations most likely to succeed.
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Affiliation(s)
- S P Conway
- Paediatric and Adult Regional Cystic Fibrosis Centres, St James' and Seacroft University Hospitals, Leeds, UK.
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12
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Abstract
Conventional management of dialysis catheter-related bacteremia involves administration of systemic antibiotics, as well as removal of the infected catheter. This approach adds burdensome and expensive procedures, and creates short-term problems for dialysis access. Recent research has shown that bacterial biofilms form routinely in the catheter lumen, and act as the nidus for bacteremic episodes. Instillation of a concentrated antibiotic-anticoagulant solution into the catheter lumen ('antibiotic lock') may permit successful treatment of the infection, while salvaging the patient's catheter. A number of recent studies have reported the success of an antibiotic lock protocol in about two thirds of cases of catheter-related bacteremia. Catheter replacement is only performed in those patients with protocol failures (persistent fever or positive surveillance blood cultures). In conclusion, routine application of an antibiotic lock protocol may reduce substantially the need for routine catheter replacement in hemodialysis patients with catheter-related bacteremia.
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Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL 035294, USA.
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13
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Abstract
A 34-year-old man with chronic inflammatory joint disease and recurrent fever over 6 years was diagnosed as having Still's disease. Treatment with corticosteroids and azathioprine was ineffective. Therefore, infliximab/ methotrexate was started. The patient subsequently developed a wasting disease with rapid weight loss, erythema nodosum, diarrhoea, progressive lymph node enlargement, and a sigmoido-vesical fistula. Histological analysis of several enlarged lymph nodes, the margins of the fistula, and the small bowel established the diagnosis of Whipple's disease (WD). The presence of Tropheryma whipplei (Tw) DNA in the tissues was confirmed by polymerase chain reaction (PCR). Careful re-evaluation of biopsies taken from the ileum and the liver 2 years earlier, which at that time was not judged to be diagnostic for WD, retrospectively showed subtle histological signs of WD and were positive for Tw DNA. In summary, infliximab treatment seems to increase the risk of exacerbation of WD. WD should be carefully ruled out prior to application of tumour necrosis factor-alpha (TNF-alpha) blockade.
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Affiliation(s)
- C Kneitz
- Department of Clinical Immunology and Rheumatology, Medizinische Poliklinik, University of Würzburg, Germany.
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14
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Yoshida S, Nakagomi K, Goto S. Abscess formation in the prevesical space and bilateral thigh muscles secondary to osteomyelitis of the pubis. ACTA ACUST UNITED AC 2009; 38:440-1. [PMID: 15764260 DOI: 10.1080/00365590410031652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 65-year-old man presented with abscess formation in the prevesical space and bilateral adductor muscles secondary to pubic osteomyelitis which was resolved by means of percutaneous drainage of the prevesical abscess. The pathway of abscess propagation can be explained on the basis of the anatomy between the prevesical space and femoral sheath.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Hamamatsu Medical Center, Hamamatsu, Japan.
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15
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Tanyaowalak W, Sunthornyothin S, Luengtaviboon K, Suankratay C, Kulwichit W. Mycotic aneurysm caused by burkholderia pseudomallei with negative blood cultures. ACTA ACUST UNITED AC 2009; 36:68-70. [PMID: 15000566 DOI: 10.1080/00365540310017465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe a case of bacterial aortitis caused by Burkholderia pseudomallei. This patient presented with prolonged fever and hoarseness of voice. Aneurysm removal with Dacron graft replacement was performed, followed by a prolonged course of antibiotics. The patient has progressed satisfactorily without recurrence of symptoms. Previous case reports are summarized.
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Affiliation(s)
- Wiriya Tanyaowalak
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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16
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Koeppe J, Belknap R, Bessesen M. Mycobacterium avium complex peritonitis in the setting of cirrhosis: Case report and review of the literature. ACTA ACUST UNITED AC 2009; 36:615-7. [PMID: 15370677 DOI: 10.1080/00365540410017626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mycobacterium avium complex is a rare cause of peritonitis. We report here the fourth case in the literature of MAC peritonitis associated with cirrhosis in the absence of AIDS, and discuss the possibility of different etiologies in persons with and without AIDS.
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Affiliation(s)
- John Koeppe
- Department of Infectious Diseases, University of Colorado Health Sciences Center, Denver, CO, USA.
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17
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Abstract
Involvement of cranial nerves was rarely reported in various rickettsioses. We present here for the first time a case of peripheral facial paralysis associated with Rickettsia typhi infection.
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Affiliation(s)
- Tatiana Vander
- Department of Neurology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel, 84105.
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18
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Abstract
PURPOSE To describe the development of Fuchs' heterochromic iridocyclitis (FHI) following bilateral ocular toxoplasmosis in an Asian Indian female. METHODS Case report of a patient with bilateral ocular toxoplasmosis who developed bilateral Fuchs' heterochromic iridocyclitis. RESULTS Features characteristic of bilateral Fuchs' heterochromic iridocyclitis developed following several attacks of bilateral toxoplasmic retinochoroiditis in a 26-year-old Indian female patient. CONCLUSION Fuchs' heterochromic iridocyclitis can develop over a period of time in patients with ocular toxoplasmosis.
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Affiliation(s)
- Sudha K Ganesh
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.
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19
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Kofteridis D, Mantadakis E, Mixaki I, Stefanidou M, Maraki S, Alexandrakis M, Samonis G. Primary cutaneous nocardiosis in 2 patients on immunosuppressants. ACTA ACUST UNITED AC 2009; 37:507-10. [PMID: 16012014 DOI: 10.1080/00365540510037948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Two female cases of primary cutaneous nocardiosis due to Nocardia brasiliensis are described. The first was associated with polymyositis and the second with chronic immune thrombocytopenic purpura. Both patients had received corticosteroids. In both cases the responsible actinomycetes were sensitive to trimethoprim/sulfamethoxazole. This drug was administered to both patients with excellent results. Treatment was continued for 3 months to prevent recurrence, a common consequence of short-term therapy. N. brasiliensis should be included in the differential diagnosis of any case of nodular lymphangitis, especially in immunocompromized patients.
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Affiliation(s)
- Diamantis Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, 710 03, Heraklion, Crete, Greece
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20
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Cheng VCC, Wu AKL, Hung IFN, Tang BSF, Lee RA, Lau SKP, Woo PCY, Yuen KY. Clinical Deterioration in Community Acquired Infections Associated with Lymphocyte Upsurge in Immunocompetent Hosts. ACTA ACUST UNITED AC 2009; 36:743-51. [PMID: 15513401 DOI: 10.1080/00365540410022602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical deterioration during the course of community-acquired infections can occur as a result of an exaggerated immune response of the host towards the inciting pathogens, leading to immune-mediated tissue damage. Whether a surge in the peripheral lymphocyte count can be used as a surrogate marker indicating the onset of immunopathological tissue damage is not known. In this study, we report the clinical presentations and outcomes of a cohort of immunocompetent patients with non-tuberculous community acquired infections who experienced clinical deterioration during hospital stay (n=85). 12 (14.1%) patients had a surge in lymphocyte count preceding their clinical deteriorations, and their diagnoses included viral pneumonitis , viral encephalitis , scrub typhus , leptospirosis , brucellosis , and dengue haemorrhagic fever . The clinical manifestations during deterioration ranged from interstitial pneumonitis , airway obstruction , CNS disturbances , and systemic capillary leak syndrome , all of which were thought to represent immunopathological tissue damages. When compared with patients without lymphocyte surge, these patients were more likely to be infected with fastidious/viral pathogens (0 vs 12; p<0.05), in addition to having lower mean baseline lymphocyte counts (403+/-181 vs 1143+/-686 cells/microl; p<0.05). We postulate that the peripheral lymphocyte count may be a useful surrogate marker indicating the presence of immunopathological damage during clinical deterioration in certain infectious diseases.
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Affiliation(s)
- Vincent C C Cheng
- Division of Infectious Diseases, Centre of Infection Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
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21
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Abstract
We report a middle aged smoker with recurrent pneumonia caused by endobronchial actinomycosis secondary to a tooth aspiration. Unlike previously reported cases, our patient was not chronically debilitated. The case suggests that a follow-up bronchoscopy is beneficial after the initiation of antibiotic therapy for endobronchial actinomycosis.
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22
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Pancharoen C, Pongpunlert W, Likitnukul S, Thisyakorn U. Post-operative Meningitis Caused by Drug-resistant Streptococcus pneumoniae: Two Case Reports. ACTA ACUST UNITED AC 2009; 36:380-1. [PMID: 15287384 DOI: 10.1080/00365540410019660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report 2 patients with post-operative meningitis caused by drug-resistant Streptococcus pneumoniae (DRSP), following correction of frontoethmoidal encephalomeningocele in 1 patient and adenotonsillectomy in the other. Both patients responded well to vancomycin plus cefotaxime. DRSP may be colonized in the upper respiratory tract and causes serious infections after surgical operation.
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Affiliation(s)
- Chitsanu Pancharoen
- Infectious Diseases Unit, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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23
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Abstract
Varicella is a common, usually self-limited infectious disease, and complications are believed to be rare. Despite the dramatic increase in invasive Streptococcus pyogenes infections associated with varicella zoster virus infections in recent years, post-varicella S. pyogenes meningitis occurs very rarely. The third case in the literature is described here.
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Affiliation(s)
- Claudia M Brandt
- Department of Medical Microbiology, University Hospital Frankfurt/Main, 69596 Frankfurt/Main, Germany.
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25
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Davies J. Teicoplanin in combination: role in the management of the febrile neutropenic patient. Eur J Haematol Suppl 2009; 54:25-8. [PMID: 8365462 DOI: 10.1111/j.1600-0609.1993.tb01902.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The spectrum of microorganisms responsible for infection in neutropenic patients has changed in the last decade, with Gram-positive organisms now predominant. New antibiotic strategies have been required and have evolved to cope with this change. In particular, the optimal timing of glycopeptide antibiotic use has been addressed. Both teicoplanin and vancomycin are highly effective agents for susceptible Gram-positive organisms. Teicoplanin has advantages in terms of ease of administration and lower toxicity, while vancomycin has proved durable over many years' use. There are now firm indications for the use of glycopeptide antibiotics in febrile neutropenic patients, including clinically defined central venous catheter infection and microbiologically documented infection with susceptible organisms. The empirical use of the glycopeptide antibiotics in combination with other agents as first-line treatment, however, is less certain. The utility of this approach remains controversial and ultimately depends on the extent to which local practice favours the emergence of Gram-positive infections in neutropenic patients.
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Affiliation(s)
- J Davies
- Royal Perth Hospital, Western Australia
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26
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Abstract
Gram-positive infections have become prevalent among neutropenic patients with cancer. A prospective, randomized, double-blind trial of teicoplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus vancomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatment of febrile neutropenic patients was undertaken among 50 consecutive patients with haematological malignancy. The patients also received piperacillin sodium, 3 g every 4 h, and tobramycin sulphate, 1.5-2 mg/kg every 8 h. Both groups (25 teicoplanin and 25 vancomycin) were comparable in age, sex, renal function, underlying disease and concurrent therapy. Among 22 patients (44%) with culture-proven infection, Gram-positive organisms were isolated in 15 (9 with bacteraemia) and Gram-negative in 11 (4 with bacteraemia). Mixed or polymicrobial infection occurred in 8 patients. Serum 1-h peak and trough levels at steady state were 41 +/- 15 and 12 +/- 3 mg/l for teicoplanin (at 14 +/- 4 days), and 40 +/- 10 and 8 +/- 5 mg/l for vancomycin (at 0.9 +/- 0.6 days). Mean elimination half-life and apparent volume of distribution at steady state were 80.5 +/- 21.5 h and 1.4 +/- 0.8 l/kg for teicoplanin, and 5.6 +/- 1.8 h and 0.6 +/- 0.2 l/kg for vancomycin. Empirical antimicrobial therapy was successful in 23 teicoplanin and 21 vancomycin patients, respectively (p = 0.67; two-tailed Fisher's exact test). Nephrotoxicity (serum creatinine > 110 mmol/l), however, was more common among vancomycin patients (10 versus 2; p = 0.02), while termination of treatment due to adverse effects was also more common among vancomycin patients (10 versus 2; p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A W Chow
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
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27
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Abstract
An important element of the evaluation of patients with infective endocarditis is the determination of an infectious source. In approximately 20-45% of cases, no source is identified. Often the specific organism involved implicates the source, as is classically described by the association of S. bovis with colonic neoplasia. Other gut organisms have been reported to infect heart valves when colorectal pathology is present, but at far less frequency than S. bovis. This report deals with the case of a 75-year-old man with Enterococcus faecalis endocarditis of an unusual source--a cecal carcinoma that was causing intermittent appendiceal obstruction and infection. This case adds to previous case reports which suggest that the occurrence of enterococcal endocarditis in the absence of a classic infectious source should lead to a search for occult colorectal pathology.
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Affiliation(s)
- E Milbrandt
- Department of Internal Medicine, St. Vincent Hospital, Indianapolis, Indiana 46260, USA
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28
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Abstract
Established cardiovascular risk factors do not fully explain the variations in the prevalence and severity of coronary heart disease. Recent evidence suggests that common chronic infections may contribute, either by direct or indirect mechanisms, to the etiology and/or progression of coronary atherosclerosis. Of the candidate infectious agents implicated, Chlamydia pneumoniae has emerged as the most likely pathogen to have a causal role. Evidence for this is based on seroepidemiologic, pathologic, and laboratory-based evidence, in addition to recent small-scale antibiotic intervention studies. Concerted efforts are now focused on the design of large prospective trials with antibiotics active against C. pneumoniae in the secondary prevention of coronary heart disease.
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Affiliation(s)
- S Gupta
- Department of Cardiological Sciences, St George's Hospital Medical School, London, U.K
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29
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Abstract
The occurrence of a retroperitoneal fibrosis (RPF) after an aorto-bifemoral bypass is unusual. A case of RPF as a complication of an infection of the graft prosthesis is reported. Computed tomography and magnetic resonance imaging prove useful in diagnosing graft infection: they may reveal periprosthetic gas or perigraft fluid persisting for several months after surgery. However, they may fail when they are performed too early, and repeat performance is suggested.
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Affiliation(s)
- C Cuny
- Service de Médecine Interne et Immunologie Clinique, Hôpital du Bocage, Dijon, France
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30
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Abstract
Endocarditis is the most devastating complication of brucellosis. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most authors, as it is considered ineffective, risking fatality. We describe a patient with BE, in whom antibiotic treatment alone resulted in complete recovery. On reviewing the literature, we found 12 additional such cases. We compared this group of 13 patients with data from 49 published cases treated with a combination of surgery and antibiotics, with a favorable outcome. Absence of congestive heart failure or a prosthetic valve, relatively mild extravalvular cardiac involvement, and a somewhat shorter disease history until initiation of treatment were characteristic of the group treated conservatively in comparison with patients who underwent surgery. In selected patients with BE, conservative antibiotic treatment may be a valid alternative to surgery.
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Affiliation(s)
- N Cohen
- Department of Internal Medicine "A", Assaf Harofeh Medical Center, Zerifin, Israel
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31
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Abstract
A patient developed fever, chills, and shortness of breath after an elective first trimester dilation and curettage. Blood cultures grew Group B streptococcus, and a transesophageal echocardiogram revealed a 2 x 2 cm vegetation on the tricuspid valve and global left ventricular hypokinesis. A 6-week course of parenteral antibiotics and vasodilator therapy resulted in resolution of the valvular vegetation as well as of the left ventricular dysfunction.
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Affiliation(s)
- S Kangavari
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Ismail H, Hellier WP, Batty V. Use of magnetic resonance imaging as the primary imaging modality in the diagnosis and follow-up of malignant external otitis. J Laryngol Otol 2006; 118:576-9. [PMID: 15318971 DOI: 10.1258/0022215041615100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Malignant external otitis (MEO) is a severe infection of the external auditory meatus caused by Pseudomonas aeruginosa. Classical features include unrelenting deep otalgia, otorrhoea and granulations in the floor of the ear canal. Treatment is generally protracted antibiotic therapy and monitoring of inflammatory markers; the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Traditionally computed tomography (CT) has been the imaging modality of choice. The authors present a case where magnetic resonance imaging (MRI) has been crucial in the diagnosis and follow up of a patient with MEO.
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Affiliation(s)
- H Ismail
- Department of Otorhinolaryngology, Southampton General Hospital, UK
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Mera R, Fontham ETH, Bravo LE, Bravo JC, Piazuelo MB, Camargo MC, Correa P. Long term follow up of patients treated for Helicobacter pylori infection. Gut 2005; 54:1536-40. [PMID: 15985559 PMCID: PMC1462952 DOI: 10.1136/gut.2005.072009] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Helicobacter pylori infection induces progressive inflammatory changes in the gastric mucosa that may lead to gastric cancer. Understanding long term effects resulting from the cure of this infection is needed to design cancer prevention strategies. METHODS A cohort of 795 adults with preneoplastic gastric lesions was randomised to receive anti-H pylori treatment and/or antioxidants. At the end of six years of intervention, those who did not receive anti-H pylori treatment were offered it. Gastric biopsies were obtained at baseline, and at 3, 6, and 12 years. A histopathology score was utilised to document changes in gastric lesions. Non-linear mixed models were used to estimate the cumulative effect of H pylori clearance on histopathology scores adjusted for follow up time, interventions, and confounders. RESULTS Ninety seven per cent of subjects were H pylori positive at baseline, and 53% were positive at 12 years. Subjects accumulated 1703 person years free of infection. A multivariate model showed a significant regression in histopathology score as a function of the square of H pylori negative time. Subjects who were H pylori negative had 14.8% more regression and 13.7% less progression than patients who were positive at 12 years (p = 0.001). The rate of healing of gastric lesions occurred more rapidly as years free of infection accumulated, and was more pronounced in less advanced lesions. CONCLUSIONS Preneoplastic gastric lesions regress at a rate equal to the square of time in patients rendered free of H pylori infection. Our findings suggest that patients with preneoplastic gastric lesions should be treated and cured of their H pylori infection.
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Affiliation(s)
- R Mera
- Department of Pathology, Louisiana State University Health Sciences Center, 1901 Perdido St, New Orleans, LA 70112, USA
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Abstract
The authors report a case of a cutaneous infection due to Bacillus licheniformis. It occurred after a wound due to a wicker splinter. The bacteriological identification was easy thanks to the very typical aspects of culture. First intention antibiotherapy given for bacterial dermo-hypodermatitis may be ineffective because Bacillus licheniformis secretes a biofilm and is frequently resistant to Beta-lactams.
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Affiliation(s)
- M A Ameur
- Laboratoire de biologie médicale, HIA Robert-Picqué Bordeaux, France.
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Abstract
OBJECTIVES Estimate the incidence and epidemiological and clinical characteristics of Tuberculosis (TB), analyzing the influence of factors such as: HIV infection, immigration, chronic diseases and styles of life. MATERIAL AND METHODS Retrospective study of patients who have diagnosed of active TB (microbiological results positive) and latent tuberculosis (Mantoux positive) during the year 2001 in the Gregorio Marañon Hospital. The variables include epidemiological, microbiological, clinical and therapeutic features. RESULTS We registered 78 patients with TB at hospital, with estimated incidence in health area of 11, 14 cases per 100,000 habitants. The mean age of were 41.98 years; with 43.6% HIV infected patients and 9% immigrants. The sputum was the sample most used for the microbiological diagnosis, we detected resistance in 30% of samples analyzed. The HIV infected patients had more frequent TB from reactivation (p=0,016). The primary site of disease was pulmonary (78%). One pulmonary infiltrate was more frequent in the thoracic X-ray. The 56% of our HIV infected patients had normal thoracic X-ray (p <0,05). The treatment more common was with four drugs and the 75% of our patients fulfilled the treatment; the HIV infected patients leaves the treatment more frequent. The global mortality was 9%. CONCLUSIONS Actually, in Madrid, the persons with HIV infection, injection drug abuse, immigration and elders in residential home were higher risk of infection for TB. For strict control of disease is need early diagnosis and supervision of treatment .
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Affiliation(s)
- I García Sánchez
- Sevicio de Medicina Interna I, Hospital General Universitario Gregorio Marañón, Madrid
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Knerlich F, Verheggen R. Neurological picture. Feeding cats might be dangerous: penetrating orbital and brain injury without neurological deficits. J Neurol Neurosurg Psychiatry 2005; 76:1359. [PMID: 16170076 PMCID: PMC1739346 DOI: 10.1136/jnnp.2004.061127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Knerlich
- Department of Neurosurgery, University Hospital of Göttingen, Göttingen, Germany
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Alves-Rodrigues EN, Ribeiro LC, Silva MD, Takiuchi A, Rabel-Filho OC, Martini-Filho D, Fontes CJF. Renal Hypersensitivity Vasculitis Associated With Dapsone. Am J Kidney Dis 2005; 46:e51-3. [PMID: 16183407 DOI: 10.1053/j.ajkd.2005.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 06/15/2005] [Indexed: 11/11/2022]
Abstract
We describe clinical and pathological features of kidney and skin involvement in a patient with hypersensitivity vasculitis associated with dapsone. Although visceral damage occurs rarely, similar skin and kidney histopathologic and immunohistochemical findings indicate that this organ is a target for type IV cell-mediated dapsone reaction. To our knowledge, this is the first reported case of renal hypersensitivity vasculitis associated with dapsone.
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Affiliation(s)
- Edson N Alves-Rodrigues
- Departamento de Clínica Médica, Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, Brazil
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Townend BS, Whyte S, Sturm JW. Cerebral abscess with pneumocephalus. Intern Med J 2005; 35:429. [PMID: 15958115 DOI: 10.1111/j.1445-5994.2005.00854.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B S Townend
- Neurology Department, Gosford Hospital, Gosford, New South Wales, Australia.
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DiNubile MJ, Chow JW, Satishchandran V, Polis A, Motyl MR, Abramson MA, Teppler H. Acquisition of resistant bowel flora during a double-blind randomized clinical trial of ertapenem versus piperacillin-tazobactam therapy for intraabdominal infections. Antimicrob Agents Chemother 2005; 49:3217-21. [PMID: 16048928 PMCID: PMC1196251 DOI: 10.1128/aac.49.8.3217-3221.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bowel colonization with resistant bacteria can develop in patients receiving broad-spectrum antimicrobial therapy. We compared the impact of two antimicrobial regimens often used to treat intraabdominal infections on susceptibility patterns of bowel flora at the end of therapy. In a double-blind clinical trial, adults with complicated intraabdominal infection requiring surgery were randomized to receive piperacillin-tazobactam (3.375 g every 6 h) or ertapenem (1 g once a day) for 4 to 14 days. Rectal swabs were obtained at baseline and at the end of study therapy to determine the acquisition rates of Enterobacteriaceae resistant to the study drug, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella species, Pseudomonas aeruginosa resistant to imipenem or piperacillin-tazobactam, and vancomycin-resistant Enterococcus faecalis or Enterococcus faecium. Treated patients were assessable for the acquisition of resistant bacteria if appropriate specimens were obtained at both time points. Enterobacteriaceae resistant to the treatment received were acquired during study therapy by 8/122 assessable piperacillin-tazobactam recipients (6.6%) compared to 0/122 assessable ertapenem recipients (P = 0.007). Neither ESBL-producing E. coli or Klebsiella species nor P. aeruginosa resistant to piperacillin-tazobactam was isolated from patients in either treatment group. Imipenem-resistant P. aeruginosa was acquired by two of the ertapenem recipients (1.6%) versus zero of the piperacillin-tazobactam recipients (P = 0.50). Vancomycin-resistant enterococci were acquired during therapy by 8/125 assessable ertapenem recipients (6.4%) versus 2/123 assessable piperacillin-tazobactam recipients (1.6%; P = 0.10). In this study, the acquisition of resistant Enterobacteriaceae occurred significantly more often in patients treated with piperacillin-tazobactam than in those treated with ertapenem.
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Affiliation(s)
- Mark J DiNubile
- Merck Research Laboratories, P.O. Box 4, BL3-4, West Point, PA 19486, USA.
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Abstract
Nocardiosis is an uncommon pediatric infection. We describe the successful treatment of Nocardia brain abscesses and meningitis in an immunocompromized boy with a history of both liver and bone marrow transplants.
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Affiliation(s)
- Emilie Chow
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Mattel Children Hospital at University of California, Los Angeles, California, USA
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Manfredi R, Sabbatani S, Chiodo F. Severe staphylococcal knee arthritis responding favourably to linezolid, after glycopeptide-rifampicin failure: a case report and literature review. ACTA ACUST UNITED AC 2005; 37:513-7. [PMID: 16012016 DOI: 10.1080/00365540510036589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A puzzling case report of a septicaemic post-surgical staphylococcal knee arthritis which did not respond to long-term courses of associated rifampicin and teicoplanin or vancomycin, despite apparently favourable in vitro susceptibility assays, but which rapidly resolved after i.v. followed by oral administration of linezolid is presented, and discussed in the context of the most recent literature evidence. The lack of response to a 14-d-long course of glycopeptides does not find explanation from the in vitro minimum inhibitory concentrations (MIC90) of involved organisms, which showed full susceptibility of Staphylococcus aureus to vancomycin and teicoplanin, and sensitivity of an accompanying Staphylococcus epidermidis isolated from blood cultures to vancomycin and rifampicin, with borderline 'intermediate' values found for teicoplanin. Since neither bone involvement nor abscess formation was of concern, effective glycopeptide and rifampicin penetration into infectious tissue should have been assured. From a clinical viewpoint, the introduction of a 2-week i.v. linezolid followed by 1 further week of oral linezolid led to complete clinical and microbiological cure, and an unexpected functional success.
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Affiliation(s)
- Roberto Manfredi
- Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Ozsöyler I, Yilik L, Bozok S, El S, Emrecan B, Biçeroğlu S, Gürbüz A. Brucella endocarditis: the importance of surgical timing after medical treatment (five cases). Prog Cardiovasc Dis 2005; 47:226-9. [PMID: 15991151 DOI: 10.1016/j.pcad.2004.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Brucella endocarditis is a disease that is hard to treat medically and has a high mortality. Immediate surgery after medical treatment is very important because delaying surgery may lead to that are difficult to repair. METHODS Five patients who were admitted to our institution with a diagnosis of Brucella endocarditis were medically treated with doxycycline (200 mg/d), rifampin (600 mg/d), and ceftriaxone (2 g/d). Preoperative mean medical treatment time was 5.2 weeks (range, 4-6 weeks). The patients were taken for operation when their general status improved. We report in this study the results of these patients. RESULTS Three patients had aortic valve replacement whereas 2 had both aortic and mitral valve replacements. No mortality or morbidity was encountered in the patients. Mean postoperative hospitalization time was 15 days (range, 12-19 days). The patients were discharged with doxycycline (200 mg/d) and rifampin (600 mg/d) but without antipyretic medication. Postoperative antibiotherapy was continued up to a mean of 3.6 months (range, 2-6 months). Mean postoperative follow-up time was 15.8 months. None of the patients needed hospitalization in their follow-up time. CONCLUSION Adequate preoperative antibiotherapy, immediate surgery, and continuation of postoperative antibiotherapy according to clinical progress seem to be a convenient treatment strategy for Brucella endocarditis.
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Affiliation(s)
- Ibrahim Ozsöyler
- Department of Cardiolvascular Surgery, Ataturk Education and Research Hospital, Izmir, Turkey
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Smiddy WE, Smiddy RJ, Ba'Arath B, Flynn HW, Murray TG, Feuer WJ, Miller D. SUBCONJUNCTIVAL ANTIBIOTICS IN THE TREATMENT OF ENDOPHTHALMITIS MANAGED WITHOUT VITRECTOMY. Retina 2005; 25:751-8. [PMID: 16141864 DOI: 10.1097/00006982-200509000-00011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if the treatment outcomes for endophthalmitis are influenced by subconjunctival antibiotics. METHODS A retrospective, nonrandomized consecutive series of patients with clinically diagnosed bacterial endophthalmitis confirmed with positive cultures who presented between December 1, 1995, and February 28, 2002, was studied. Patients with cataract surgery, glaucoma filtering blebs, or trauma who presented with visual acuity of hand motions or better were included. All patients received intravitreal and topical antibiotics. Management by pars plana vitrectomy or vitreous tap and use or nonuse of subconjunctival antibiotics were at the discretion of the treating physician. RESULTS There were 59 patients identified; 54 met the follow-up criteria. These patients were divided into two groups based on whether subconjunctival antibiotics were used (group ABX; n = 21) or not used (group noABX; n = 33). The median pretreatment visual acuity was hand motions in both groups. The median age in both groups was 74 years. Etiology, duration of symptoms, vitreous culture organisms, percentage of cases with wound complications such as leaks or vitreous incarceration, and intraocular lens type were similar in the two study groups. Intravitreal and topical antibiotics and corticosteroids used were not significantly different in the two groups, except that topical ceftazidime was used less frequently in group ABX than in group noABX (43% vs. 82%, respectively; P = 0.007). The median follow-up was 13 months in both groups (range: 3-87 months for group ABX and 3-63 months for group noABX). Final visual acuity in groups ABX and noABX was at least 20/50 (33% vs. 39%, respectively), 20/60 to 5/200 (29% vs. 39%, respectively), 4/200 to better than hand motions (0 vs. 3%, respectively), or hand motions or worse (38% vs. 18%, respectively). These differences were not significant (P = 0.37). Reinjection rates (14% vs. 15%, respectively) were also similar in groups ABX and noABX. The additional procedures rate was significantly higher in group ABX than in group noABX (P = 0.024), with cumulative rates of 33% and 3%, respectively, at the 12-month follow-up. CONCLUSIONS These data suggest that subconjunctival antibiotics may not be necessary to treat infectious endophthalmitis managed with otherwise standard tap and injection techniques and topical antibiotics.
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Affiliation(s)
- William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
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Abstract
HYPOTHESIS Bowel preparation traditionally consists of cathartics, oral antibiotics, and intravenous antibiotics. We hypothesize that the use of oral antibiotics in bowel preparation results in a higher rate of postoperative Clostridium difficile colitis. DESIGN Retrospective case-controlled study of elective colon surgery patients; January 1997 to June 2003. SETTING Tertiary care veterans administration hospital. PATIENTS Records of patients who underwent elective colorectal surgery (n = 304) were reviewed. Patients with bowel obstruction or emergent operation were excluded. MAIN OUTCOME MEASURE Detection of C difficile toxin A/B by enzyme-linked immunosorbent assay in a stool specimen within 30 days of surgery. RESULTS All 304 patients received both cathartics and intravenous antibiotics. Of 304 patients, 107 (35.1%) received oral antibiotics. The rate of postoperative C difficile colitis was 4.2% in the entire study population. The rate of C difficile infection was higher in patients who received oral antibiotics (7.4%) compared with patients who did not receive oral antibiotics (2.6%; P = .03). There were no C difficile-related mortalities. CONCLUSION Oral nonabsorbable antibiotics in bowel preparation resulted in a higher rate of C difficile infection. This may be due to the additional effect of oral antibiotics on normal bowel flora. We recommend that oral nonabsorbable antibiotics not be used in preoperative bowel preparation regimens since postoperative C difficile infection can lead to additional morbidity, length of stay, and hospital costs.
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Affiliation(s)
- Sherry M Wren
- Palo Alto Veterans Health Care System and Department of Surgery, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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Abstract
INTRODUCTION Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. CASE REPORT A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. DISCUSSION The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.
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Affiliation(s)
- M Hamm
- Unité de Dermatologie, Centre Hospitalier William Morey, Chalon-sur-Saône
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Durand ML, Kim IK, D'Amico DJ, Loewenstein JI, Tobin EH, Kieval SJ, Martin SS, Azar DT, Miller FS, Lujan BJ, Miller JW. Successful treatment of Fusarium endophthalmitis with voriconazole and Aspergillus endophthalmitis with voriconazole plus caspofungin. Am J Ophthalmol 2005; 140:552-4. [PMID: 16139017 DOI: 10.1016/j.ajo.2005.03.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 03/05/2005] [Accepted: 03/07/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE To report successful treatment of exogenous Fusarium and Aspergillus endophthalmitis with new antifungal agents. DESIGN Interventional case report. METHODS Treatment of two cases is reviewed. RESULTS A 64-year-old man developed post-cataract Fusarium moniliforme endophthalmitis. Infection persisted despite removal of the intraocular lens, three vitrectomies, and five intravitreal injections of amphotericin. Inflammation resolved and vision improved from 20/80 to 20/40 on 6 months of oral voriconazole. A 55-year-old man developed post-cataract intraocular inflammation. After three vitrectomies and removal of the intraocular lens, Aspergillus fumigatus endophthalmitis was diagnosed. Intravitreal amphotericin and systemic voriconazole were given, but one week later there were early signs of recurrence. Intravenous caspofungin was added and the eye improved. Caspofungin was continued for 6 weeks and voriconazole for 6 months. Vision improved from counting fingers to 20/80 at 6 months and 20/25 at 23 months. CONCLUSION Voriconazole is a promising new therapy for Fusarium and Aspergillus endophthalmitis. Caspofungin may act synergistically with voriconazole in treating Aspergillus endophthalmitis.
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Affiliation(s)
- Marlene L Durand
- Infectious Disease Service, Massachusetts Eye and Ear Infirmary (MEEI), 243 Charles Street, Boston, MA 02114, USA.
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Baurmash HD, Monto M. Delayed Healing Human Bite Wounds of the Orofacial Area Managed With Immediate Primary Closure: Treatment Rationale. J Oral Maxillofac Surg 2005; 63:1391-7. [PMID: 16122610 DOI: 10.1016/j.joms.2005.05.165] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Harold D Baurmash
- Department of Oral and Maxillofacial Surgery, School of Dental and Oral Surgery, Columbia University, New York, NY, USA.
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