1/13. Emphysematous cystitis due to clostridium perfringens and candida albicans in two patients with hematologic malignant conditions.BACKGROUND. fever, abdominal pain, and hematuria developed in two patients with hematologic malignant conditions (multiple myeloma and agnogenic myeloid metaplasia). Each patient was found to have emphysematous cystitis (EC), secondary to clostridium perfringens and candida albicans, respectively. Both patients had debilitated general medical conditions, compromised immune function, prior treatment with broad-spectrum antibiotics and corticosteroids, bladder outlet obstruction, and indwelling Foley catheters as predisposing factors to EC. Neither was diabetic. methods. These cases provide an opportunity to review the related medical literature on the pathophysiology and management of this uncommon entity. RESULTS. Treatment consists of control of underlying diabetes (if present), administration of appropriate antibiotics, establishment of urinary drainage, provision of supportive general medical care, exclusion of the presence of a bladder fistula, and surgical debridement only when unavoidable. CONCLUSIONS. EC should be part of the differential diagnosis in patients with cancer who have fever, abdominal pain, and hematuria.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/13. Spontaneous bacterial peritonitis due to clostridium perfringens in a patient with liver cirrhosis and pure red cell aplasia.A 63-year-old man with decompensated liver cirrhosis and pure red cell aplasia complained of pyrexia, abdominal distention and abdominal pain. A diagnosis of spontaneous bacterial peritonitis (SBP), Conn's syndrome, was made upon the isolation of an anaerobe clostridium perfringens from both ascitic fluid and peripheral blood. The bacteria were found to be susceptible to piperacillin, and administration of the antimicrobial agent markedly improved his SBP. The anaerobes should be kept in mind as one of the possible pathogens of SBP, although anaerobic infection has been reported to be quite rare in the disease.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/13. probiotics in relapsing and chronic diarrhea.diarrhea is common in oncology patients; if it becomes chronic and relapsing, it can be debilitating, hinder planned management, and be difficult to treat. The authors describe two patients, one with leukemia who developed recurrent clostridium difficile colitis and another who developed chronic diarrhea after bone marrow transplantation. In both patients, administration of antibiotics was suspected as the cause. In one patient, relapsing diarrhea resolved after probiotics were given with a 2-day course of metronidazole, and in the other patient, chronic diarrhea resolved after probiotics were given; resolution was maintained after the probiotics were stopped. probiotics may offer a way to bring about resolution in antibiotic-associated chronic diarrhea.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/13. A fatal case of clostridium sordellii septic shock syndrome associated with medical abortion.BACKGROUND: Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. CASE: A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. CONCLUSION: The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/13. Severe sepsis following wound infection by an unusual organism--Clostridium novyi.We present a case of post-operative wound infection with Clostridium novyi in a non-intravenous drug user. Clinical features included progressive cellulitis despite being on antibiotics, accompanied by hypotension, marked leucocytosis and oedema but minimal fever. While established infection with this organism is associated with high mortality, our patient survived. The administration of clindamycin and intravenous immunoglobulin in addition to early surgical assessment and aggressive debridement of affected tissue may have contributed to this successful outcome. To our knowledge, this is the only reported post-operative wound infection due to this pathogen.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/13. clostridium difficile infection in orthopaedic patients.In a review of the results of toxin assays, twenty-five orthopaedic patients who had a clostridium difficile infection and associated diarrhea were identified. The infection was due to the use of antibiotics in all but one patient. Seventeen patients had received the antibiotics prophylactically. The two most commonly implicated antibiotics were cefazolin and clindamycin, because those drugs had been commonly used for prophylaxis at the study institutions. However, other antibiotics were implicated. There was a positive correlation between the delay in diagnosis and the severity of the illness. A white blood-cell count of more than 20 x 10(9) per liter indicated severe disease in our survey. The possibility of clostridium difficile infection should be considered in patients who have signs and symptoms that mimic those of intestinal obstruction. patients who have an unexplained fever or high white blood-cell count and in whom diarrhea develops in the postoperative period should be treated immediately with metronidazole, and a specimen of stool should be obtained for an assay for clostridium difficile toxin. If the diagnosis of clostridium difficile infection is confirmed by the presence of toxin in the stool and the patient has persistent, severe diarrhea, oral administration of vancomycin should be added to the regimen. The duration of antibiotic prophylaxis should be minimized to decrease the risk of clostridium difficile colitis.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/13. Primary infection of ascitic fluid with clostridium difficile.A case of a primary infection of ascitic fluid with a toxigenic strain of clostridium difficile is described. The strain belonged to the serogroup H which is often implicated in pseudomembranous colitis. Nevertheless, our patient did not have any sign of colitis or diarrhoea before the ascitic infection. She was successfully treated by the intravenous administration of metronidazole but relapsed a few weeks later. A similar strain of serogroup H was again isolated.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/13. Clostridial sepsis after abortion with PGF2alpha and intracervical laminaria tents--a case report.A case of clostridial endomyometritis and sepsis necessitating total abdominal hysterectomy which occurred 12 hours following abortion induced with intraamniotic administration of prostaglandin F2 alpha and laminaria tent insertion is discussed. Cultures from cervical, blood, and surgical specimens all yielded clostridium perfringens. Intrauterine contamination with this microorganism most likely followed the insertion of laminaria tents through the cervical os, which was colonized with C. perfringens. Since C. perfringens may be present in the microflora of the lower female genital tract, great care must be taken to cleanse this area prior to intracervical laminaria tent insertion.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
9/13. Uneventful administration of plasma products in a recipient with T-activated red cells.A patient with T-polyagglutinable red cells and a severe coagulopathy provided an opportunity to observe the results of plasma transfusion in the face of T-activation. The patient was a 52-year-old Navajo Indian with a perforated gall bladder and related sepsis due to clostridium perfringens. The gall bladder was removed surgically. Postoperatively, he had severe thrombocytopenia, and prolonged partial thromboplastin and prothrombin times. The patient's red cells were agglutinated by arachis hypogaea and glycine soja lectins but were unagglutinated by extracts of salvia horminum, salvia sclarea, and Bandeiraea simplicifolia. No untoward reactions or any evidence of hemolysis were observed when the patient was given platelet concentrates and 4 units of single-donor plasma. Serial plasma hemoglobin and haptoglobin levels documented that there was no hemolysis. His coagulopathy responded, and he had a successful surgical re-exploration and recovery. This case documents that serious adverse consequences do not necessarily follow transfusion of plasma in a recipient with T-activated red cells. T-activation is a relative but not absolute contraindication to plasma transfusion.- - - - - - - - - - ranking = 4keywords = administration (Clic here for more details about this article) |
10/13. Pseudomembranous colitis and wound infection following perioperative use of multiple antibiotics.The prophylactic use of antibiotics in elective surgery of the colon is accepted practice, but it has inherent risks. The authors report the case of a 70-year-old woman who had wound infection and severe, relapsing pseudomembranous colitis due to clostridium difficile after a short course of antibiotics given orally and parenterally at the time of elective resection of the colon. Perioperatively, she received erythromycin base and neomycin orally, plus netilmicin and metronidazole intravenously. Although the concomitant administration of parenteral antibiotics may enhance the benefit of antibiotics given orally before operation, this does not entirely prevent wound infection. Until the relation between the number of drugs and risk of antibiotic-associated colitis is more clearly defined, caution should be exercised in the use of multiple antibiotics in elective colonic surgery.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
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