1/3. haemophilus influenzae infections in adults: report of nine cases and a review of the literature.haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. in vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/3. Bacterial bronchitis and bronchiectasis in human immunodeficiency virus infection.BACKGROUND: Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (hiv) infection. We noted an increased incidence of bacterial bronchitis and bronchiectasis in our patients with hiv infection. methods: This study was conducted on persons with hiv infection at a county hospital and clinic. bronchiectasis was diagnosed by bronchogram and computed tomography in one patient and by computed tomography alone in two others. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. bronchoscopy with broncho-alveolar lavage was performed in patients with bronchitis to eliminate other causes of bronchial inflammation. RESULTS: Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these patients was 0.061 x 10(9)/L (range, 0.001 to 0.203 x 10(9)/L). The most common pathogens in 18 episodes of bacterial bronchitis were haemophilus influenzae and streptococcus pneumoniae (five episodes each) and pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patients with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, hiv infection are described. Their mean CD4 cell count was 0.03 x 10(9)/L (range, 0.024 to 0.037 x 10(9)/L). haemophilus influenzae, staphylococcus aureus, Pseudomonas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain. CONCLUSIONS: Recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with hiv infection. Repeated bacterial bronchitis may lead to bronchiectasis, which may be more common in hiv infection than generally appreciated.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
3/3. Intravenous immunoglobulin replacement therapy for common variable immunodeficiency during pregnancy.patients with common variable immunodeficiency (CVID), characterized by impaired antibody production, have a high susceptibility to bacterial infections and need supplements of immunoglobulin g (IgG). We report two pregnancies in a woman with CVID. Differences in the outcome of the two pregnancies suggest the need for adjustment of replacement therapy during pregnancy.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |