1/9. vaginitis: case reports and brief review.vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome.peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Septic candida krusei thrombophlebitis of inferior vena cava with persistent fungemia successfully treated by new antifungal agents.Treatment of candida krusei fungemia can be problematic. We describe a 44-year-old critically ill, non-immunocompromised patient who had persistent candida krusei fungemia complicated with septic thrombophlebitis of the inferior vena cava. Successful treatment was achieved by parenteral caspofungin followed by prolonged oral voriconazole. Persistent fungemia in the face of ongoing antifungal therapy and prompt removal of central line should alert physicians to the diagnosis of septic thrombophlebitis. Though combined therapy with amphotericin b and surgical intervention probably remains the treatment of choice, prolonged new antifungal agents, which have better efficacy, tolerability and bioavailability, may be a useful alternative where the central veins are relatively inaccessible or the patient is at high operative risk.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Invasive candidiasis in infants: experience from saudi arabia.There are few reports about invasive candidiasis in infants in the tropics in general and in the Kingdom of saudi arabia in particular. Two Saudi infants with invasive candidiasis are reported and their clinical features and response to treatment are compared with that found in the paediatric literature, mainly from the developed world. Prematurity, low birthweight, invasive procedures, long hospital stay and prolonged use of broad-spectrum antibiotics were found to be predisposing factors in the two patients, and we believe that a lack of awareness of these by the referring physicians led to a delay in diagnosis. The need for greater awareness and vigilance, and the dangers inherent in overlooking isolates of candida from clinical materials are emphasized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. gallbladder and biliary tract candidiasis: nine cases and review.We review biliary tract and gallbladder candidiasis and define patient demographics, risk factors, prognostic factors, and treatment strategies for this infection. This is a 3-year retrospective review of our experience with this disease and a review of the English-language literature. Thirty-one cases of biliary tract and gallbladder candidiasis, including nine in our series, have been examined. The same risk factors that predispose patients to other forms of candidal infection are implicated here. No mortality was found with uncomplicated candidal cholecystitis in nonneutropenic patients treated with cholecystectomy alone. patients with associated extrabiliary tract candidiasis or candidemia had worse outcomes and required both surgical intervention and antifungal therapy. When risk factors exist for the development of biliary tract or gallbladder candidiasis, the physician should be alert to this possibility. There is no need for antifungal therapy in cases of isolated candidiasis of the gallbladder in nonneutropenic patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Synchronous bacterial and fungal septicemia. A marker for the critically ill surgical patient.Mixed septicemia (synchronous fungal and bacterial septicemia) is an occasional, but often fatal occurrence in the critically ill patient. We reviewed 14 such cases at two hospitals. Twelve of 14 patients were in the surgical intensive care unit. Eleven patients had an average of 2.7 major surgical procedures (range 2 to 4); persistent post-operative peritoneal sepsis was common occurring in 9 patients. bacteremia preceded mixed septicemia in 8 of 14 cases and gram negative enteric bacilli were the most common causes of bacteremia. fungemia was due to candida species in 13 of 14 patients and followed prolonged antibiotic therapy. The diagnosis of disseminated candidiasis was suspected during life in 13 patients and proven in six. Mixed septicemia is a marker for a distinct population of critically ill surgical patients with a high overall mortality (78% in this study). culture of both a fungal and bacterial pathogen in a blood culture, especially if preceded by bacteremia, should alert the physician to strongly suspect disseminated fungal infection and to commence appropriate treatment. mortality is likely to remain high unless the underlying disease states can be rapidly corrected and infection controlled.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Thromboembolic and infectious complications of total artificial heart implantation.Thromboembolic and infectious events were found to be major complications of long-term total artificial heart implantation in two patients. Similar complications have been reported in other patients, as well as in animal studies. The thromboembolic events and the infectious complications appear to be interrelated. On the one hand, thrombi located on the valves and at the vascular anastomoses of the artificial heart were found to be infected at autopsy; such infections are known to exacerbate formation of thromboemboli. On the other hand, the generation of microthrombi may have contributed to the RES blockade seen in our patients. We hypothesize that this RES blockade led to a progressive decrease in lymphoid system function and impaired the patients' capacity to clear microorganisms from the circulation. These phenomena arose, in part, from the design of the artificial heart and were exacerbated by associated therapy, such as blood transfusions. Our data suggest several measures that might be taken in order to reduce the severity of both the thrombogenic and infectious complications. Improved anticoagulation regimens, which increase the ability of the physician to maintain the proper balance between thrombotic and hemorrhagic potential, are needed. This may require not only improved methods of monitoring anticoagulation and predicting changes in the effectiveness of various agents as other events supervene, but also new anticoagulant and antithrombotic drugs, for example, low molecular weight heparins and prostacyclin derivatives. It is also clear that the design of the artificial heart should be modified in order to improve fluid dynamics so that they will approximate as closely as possible those of the natural heart. This includes redesigning the mounting of the valves to eliminate crevices and discontinuities that allow stagnant flow and predispose to thrombus formation as well as imposing a dP/dt that minimizes shear-related hemolysis, thereby minimizing the need for blood transfusions. Prevention of infections presents a more difficult problem. Transcutaneous lines (regardless of their use) are an obvious route for infection, and attention should be given to minimizing the number and length of use of monitoring lines. However, until a totally implantable drive system is available, the drive lines will remain a potential avenue for the introduction of infections. The risk may be minimized by rigorous attention to care of the exit sites and by improved designs that will provide a better mechanical barrier by, for example, enhancing epithelial ingrowth into the materials of the drive line.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Systemic candidiasis following cardiac surgery: an improved outlook.Systemic candidiasis following cardiac surgery, previously regarded as fatal, has now a much improved prognosis. prognosis depends largely on early diagnosis and treatment. Four of five patients we recently treated for this disease survived. The presence of several predisposing factors in a febrile patient following cardiac surgery should alert the physician to the possibility of this disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. An outbreak of candida parapsilosis prosthetic valve endocarditis.candida parapsilosis, an important nosocomial pathogen and the most common species of candida found on the hands of health care workers, is a rare cause of prosthetic valve endocarditis (PVE). From March through June 1994, four cases of C. parapsilosis PVE were diagnosed at a 400-bed community hospital. The mean time to presentation after valve replacement surgery was 148 days (range, 20 to 345). Three of the four patients died of complications of PVE. Multiple environmental cultures were performed, and only one was positive for C. parapsilosis. Cultures from the bypass pump, cell saver, cardioplegia solution, and subsequent valves were all negative. All valve replacements were performed by the same operating room team. Interviews with the surgeon and physician assistant, the only personnel involved in all cases, revealed that their hypoallergenic gloves were subject to frequent tears during valve replacement procedures, often requiring several glove changes per procedure. hand cultures of personnel were obtained, and cultures from 20 individuals (26%) were positive for C. parapsilosis. hand cultures of the surgeon and physician assistant obtained 8 months after the last case had surgery were negative for yeasts. molecular typing of the 3 available case isolates, 14 epidemiologically unrelated patient isolates, 1 environmental isolate, and 20 hand isolates was performed by electrophoretic karyotyping and restriction endonuclease analysis of genomic dna using restriction enzymes BssHII and EagI followed by pulsed field gel electrophoresis. The three case isolates were identical by restriction endonuclease analysis of genomic dna, and two of the three shared the same electrophoretic karyotyping profile. The remaining patient, environmental, and hand isolates represented 29 different dna types and were distinctly different from the case isolates. All of the isolates tested were susceptible to amphotericin b, 5FC, fluconazole, and itraconazole. The circumstantial evidence suggests the probability of glove tears during valve replacement surgery and subsequent transmission of C. parapsilosis to patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |